Renal Function And Kidney Disease

Question 1

What % of normal cardiac output do kidneys receive?

Answer 1

25%

Question 2

What is the estimated glomerular filtration rate?

Answer 2

Estimated GFR is based on a formula derived from patients age, gender, ethnicity, and serum creatine
Normal GFR= 100 mL/min

Question 3

What is the classification of chronic kidney disease?

Answer 3

Stage 1- eGFR 90+- normal kidney function with urinary or structural abnormalities
Stage 2- eGFR 60-89- mildly reduced kidney function with urinary or structural abnormalities
Stage 3- eGFR 30-59- moderately reduced kidney function- with or without urinary abnormalities
Stage 4- eGFR 15-29- severely reduced kidney function- with or without urinary abnormalities
Stage 5- eGFR <15- established renal failure- very severe or dialysis-dependent kidney function

Question 4

Why do kidneys fail?

Answer 4

Acute kidney injury (AKI)- a sudden decrease in kidney function needs urgent assessment to sort out the primary problem, a decrease in GFR which occurs within hours to days and is potentially reversible
Chronic kidney disease

Question 5

What does normal kidney function depend on?

Answer 5

Perfusion with adequate pressure and oxygen
Intact nephrons (glomeruli and tubules)
Free urinary drainage

Question 6

What is acute kidney injury?

Answer 6

A sudden decrease in kidney function, needs urgent assessment to sort out the problem
A decrease in GFR which occurs within hours to days and is potentially reversible

Question 7

What are the 3 kinds of acute kidney injury?

Answer 7

Pre-renal- disorder perfusion of a kidney which is structurally normal
Renal- damage to the nephrons, often after prolonged pre-renal insults
Post-renal- urinary drainage obstructed

Question 8

What are the causes of pre-renal AKI?

Answer 8

True volume depletion- blood loss, GI losses
Hypotension- septic shock, cardiogenic shock
Oedematous states- cardiac failure, liver failure (reduced kidney perfusion)

Question 9

What is acute tubular necrosis?

Answer 9

A kidney disorder involving damage to the tubule cells of the kidney’s which can lead to acute kidney failure

Question 10

What are the causes of acute tubular necrosis?

Answer 10

Renal ischaemia followed by reperfusion- severe pre-renal AKI
Exposure to nephrotoxins

Question 11

What is chronic kidney disease?

Answer 11

A decrease in GFR which occurs over months or years and is usually reversible

Question 12

What are the causes of chronic kidney disease?

Answer 12

Diabetic neuropathy
Hypertensive renal vascular disease
Glomerulonephritis
Polycystic kidney disease

Question 13

What are the risk factors for chronic kidney disease?

Answer 13

Diabetes
Hypertension 
Smoking 
Dyslipidaemia 
Age
Male>female 
Family history/genetics 
Cardiac disease

Question 14

What is the treatment for CKD?

Answer 14

Dialysis- used to remove excess waste products and excess fluid from the blood
Kidney transplant

Question 15

What are the two methods of dialysis?

Answer 15

Haemodialysis

Peritoneal dialysis

Question 16

What is haemodiaysis?

Answer 16

Usually hospital based in renal units 
Nurse delivered 
Three times a week 
Needs access to blood 
Expensive 
Restricted to sites with dialysis machines

Question 17

What is peritoneal dialysis?

Answer 17

Home based
Preferred for children and older patients
Patient performs dialysis
Daily
Uses abdominal cavity
Cheaper
Can be done virtually anywhere in the world
Toxins filter from the blood into the dialysis fluid and then drain out of the body

Question 18

In what ways can peritoneal dialysis take place?

Answer 18

Abdominal catheter

Question 19

In what ways can haemodialysis take place?

Answer 19

Internal vascular fistula

Central vein access

Question 20

What is the success rate of a kidney transplant?

Answer 20

> 95% success rate
Better quality of life for patient
Much better survival (quantity of life) for patient
Much cheaper than dialysis
Life long drug treatment to suppress the immune system and prevent rejection of the transplant symptoms

Question 21

What are some complications in the use of immunosuppression?

Answer 21

Infections- viral (herpes simplex, papillomavirus) and fungal (candidiasis)
Neoplasia- squamous cell carcinoma, basal cell carcinoma, Non-Hodgkin’s lymphoma

Question 22

What are the side-effects of immunosuppressive drugs?

Answer 22

Drug-influence gingival enlargement 
Alopecia 
Cataracts 
Arrhythmias 
Hypertension 
Peptic ulcer disease
Pancreatitis 
Hypokalemia 
Infertility 
Osteoporosis 
Diabetes mellitus 
Herpes zoster

Question 23

What are some common orofacial problems associated with CKD itself or caused by the therapy?

Answer 23

Poor OH 
Halitosis 
Increased tooth mobility 
Premature tooth loss 
Malocclusion 
Erosion
Delayed eruption 
Increased deposits of calculus 
Gingival overgrowth 
Ulceration 
Stomatitis 
Petechia 
Nodules 
Erythematous patch 
Candidiasis 
Leukoplakia 
Lichen plans 
Epstein-Barr virus like lesions
Non-Hodgkin’s lymphoma 
Decreased thickness of cortical bone 
Radiolucent lesions
Abnormal bone healing after extraction 
Bone demineralisation 
Acute suppurative sialadentitis (salivary gland infection)