Renal Function And Kidney Disease Flashcards
What % of normal cardiac output do kidneys receive?
25%
What is the estimated glomerular filtration rate?
Estimated GFR is based on a formula derived from patients age, gender, ethnicity, and serum creatine
Normal GFR= 100 mL/min
What is the classification of chronic kidney disease?
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
Why do kidneys fail?
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
What does normal kidney function depend on?
Perfusion with adequate pressure and oxygen
Intact nephrons (glomeruli and tubules)
Free urinary drainage
What is acute kidney injury?
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
What are the 3 kinds of acute kidney injury?
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
What are the causes of pre-renal AKI?
True volume depletion- blood loss, GI losses
Hypotension- septic shock, cardiogenic shock
Oedematous states- cardiac failure, liver failure (reduced kidney perfusion)
What is acute tubular necrosis?
A kidney disorder involving damage to the tubule cells of the kidney’s which can lead to acute kidney failure
What are the causes of acute tubular necrosis?
Renal ischaemia followed by reperfusion- severe pre-renal AKI
Exposure to nephrotoxins
What is chronic kidney disease?
A decrease in GFR which occurs over months or years and is usually reversible
What are the causes of chronic kidney disease?
Diabetic neuropathy
Hypertensive renal vascular disease
Glomerulonephritis
Polycystic kidney disease
What are the risk factors for chronic kidney disease?
Diabetes Hypertension Smoking Dyslipidaemia Age Male>female Family history/genetics Cardiac disease
What is the treatment for CKD?
Dialysis- used to remove excess waste products and excess fluid from the blood
Kidney transplant
What are the two methods of dialysis?
Haemodialysis
Peritoneal dialysis
What is haemodiaysis?
Usually hospital based in renal units Nurse delivered Three times a week Needs access to blood Expensive Restricted to sites with dialysis machines
What is peritoneal dialysis?
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
In what ways can peritoneal dialysis take place?
Abdominal catheter
In what ways can haemodialysis take place?
Internal vascular fistula
Central vein access
What is the success rate of a kidney transplant?
> 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
What are some complications in the use of immunosuppression?
Infections- viral (herpes simplex, papillomavirus) and fungal (candidiasis)
Neoplasia- squamous cell carcinoma, basal cell carcinoma, Non-Hodgkin’s lymphoma
What are the side-effects of immunosuppressive drugs?
Drug-influence gingival enlargement Alopecia Cataracts Arrhythmias Hypertension Peptic ulcer disease Pancreatitis Hypokalemia Infertility Osteoporosis Diabetes mellitus Herpes zoster
What are some common orofacial problems associated with CKD itself or caused by the therapy?
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)
