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2 - Diseases Of The Human System > Renal Medicine > Flashcards

Renal Medicine Flashcards

1
Q

What is dysuria and what is uraemia?

A

dysuria = pain upon urination
uaraemia = increased urea

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2
Q

What are the methods of measuring renal function and how do they work?

A
  • Serum UREA
    Also rises with dehydration
  • Serum CREATININE
    Good general guide to renal function
  • eGFR – Estimated Glomerular filtration rate
    Modern quick way of looking at renal function calculated from U&Es measurement
  • 24hr urine collection
    Creatinine clearance – best measure
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3
Q

What is the best way to measure renal function?

A

eGFR – Estimated Glomerular filtration rate

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4
Q

What does renal failure cause?

A
  • loss of renal excretory function
  • loss of water and electrolyte balance
  • loss of acid base balance
  • loss of renal endocrine function (erythropoietin, calcium metabolism, renin secretion)
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5
Q

What are the two types of renal failure?

A

Acute Renal Failure
* Rapid loss of renal function
* Usually over hours or days
Chronic Renal failure
* Gradual loss of renal function
* Usually over many years

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6
Q

What are the pre-renal causes of failure?

A
  • Hypoperfusion of the kidney
  • shock
  • Renal artery or Aorta disease
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7
Q

What are renal causes of failure?

A
  • Chronic disease, drug damage, trauma, infection
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8
Q

What are the post renal causes of failure?

A

renal outflow obstruction

enlarged prostate, kidney stones, tumours

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9
Q

What measurement is rapid loss of renal failure measured by in ARF?

A

Creatinine >200μmol/L

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10
Q

What are the intial symptoms of ARF?

A
  • Anuric initially (no urine) with volume overload
  • Ankle oedema (if ambulatory), sacral oedema (if bed bound)
  • Pulmonary oedema & breathlessness
  • Raised Jugular Venous Pressure (JVP)
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11
Q

What are the gradual symptoms of ARF?

A
  • Gradually progresses to polyuria
  • Healing restores filtration before concentration ability
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12
Q

What can develop due to ARF?

A
  • development of Hyperkalaemia (high K+)
  • Can lead to cardiac arrest
  • development of Uraemia and Acidosis
  • High urea
  • Low bicarbonate
  • Increased respiratory excretion of CO2
  • Raised respiratory rate
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13
Q

What are the causes of ARF and what is the treatment?

A
  • Usually a PRE-RENAL cause
  • USUALLY reversible with TIME
  • renal support until recover
  • dialysis
  • nutrition
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14
Q

Primary/ secondary causes of CRF?

A

Primary (rare)
* Glomerulonephritis
* Polycystic Kidney disease

Secondary
* Diabetes (30%)
* Hypertension (20%)
* drug therapy
* Vasculitis
* Renal Artery disease/Aorta disease

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15
Q

Symptoms of glomerulonephritis and progression

A
  • haematuria/proteinuria
  • otherwise healthy individual
  • gradual progression to:
  • hypertension
  • chronic renal failure
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16
Q

What is nephrotic syndrome?

A

Complication of Glomerulonephritis
* excessive loss of protein in the urine - >3g in 24hrs
* Hypoalbuminaemia
* loss of plasma oncotic pressure * tissue swelling (oedema)

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17
Q

What does nephrotic syndrome result in?

A

HYPERcoagulable state
* Loss of clotting factors – AT3 deficiency (due to hypoalbuminaemia)
* Dehydration raises other coagulation factor concentrations

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18
Q

What drugs cause renal disease?

A

NSAIDs
* inhibit glomerular blood flow
* Cause interstitial nephritis
* Avoid in renal disease if possible

Nephrotoxic drugs
* cyclosporin

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19
Q

What is renal vascular disease?

A

Reduced blood flow to the kidney
* Atheroma of renal artery/aorta
* Hypertension – narrowing of renal artery

Microangiopathy
* Immune reaction causing small blood vessel damage, RBC damage and thrombosis
* E Coli 0157

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20
Q

Multiple myeloma

A
  • Plasma cell tumour
  • Excess light chain production ‘clogs’ kidney
  • Tubular nephritis results
21
Q

Goodpasture’s syndrome

A
  • Anti-glomerular basement membrane antibody
    (anti-gbm)
22
Q

Vasculitis

A

inflammation of blood vessels that can affect the kidney due to systemic lupus erythematosus (SLE)

23
Q

What is polycystic kidney disease?

A

gene mutation that causes multiple cysts in the renal parenchyma
*Enlarged kidney
* Progressive destruction of normal kidney
* Gradual renal failure

24
Q

What is end stage renal disease classfied as?

measurements

A
  • eGFR <15ml/min
  • Creatinine 800-1000μmol/L
25
Q

How can you reduce the rate of decline?

A
  • Eliminate nephrotoxic drugs
  • Control hypertension
  • Control diabetes
  • Control vasculitic disease
  • Steroids/other immune suppressant drugs
26
Q

How can you correct fluid balance and deficiencies?

A

Correct Fluid Balance
* Restrict fluid intake
* Restrict salt, potassium, protein

CORRECT deficiencies
* Anaemia (erythropoietin)
* Calcium (vitamin D)

27
Q

What can you remove?

A
  • Renal stones (calculi)
  • Prostate enlargement
28
Q

What are the conditions caused by CRF?

A
  • anaemia
  • hypertension
  • renal bone disease
  • low Ca, high PO4
  • hyperparathyroidism
  • osteomalacia
29
Q

What are the symptoms of CRF?

A
  • polyuria
  • nocturia
  • tired & weak
  • nausea
30
Q

What are symptoms of renal disease in dentistry?

A

oral opportunistic infections
* Fungal and viral infections/reactivations * prone to post-op infections

dry mouth & taste disturbance
* Fluid restriction and electrolyte disturbance

bleeding tendencies
* Platelet dysfunction

renal osteodystrophy
- lamina dura lost
- bony radiolucencies
* Secondary hyperparathyroidism increases osteoclast activity

31
Q

What is renal dialysis?

A

A PASSIVE process
* Diffusion across concentration gradients
* Allows intermittent correction of changes in plasma concentration of small molecules
* Not true ‘renal replacement’
* Significant lifestyle restrictions remain

32
Q

What is haemodialysis?

A

blood is pumped from arteriovenous fistusa into a dialyser
in the dialyser waste products filter from the blood through an artifical membrane into a fluid called the dialysate

33
Q

What is peritoneal dialysis?

A

implanted catheter passes fluid through peritoneal cavity and sucks it out again

34
Q

How are renal endocrine components replaced?

A

Erythropoietin
* replaced by EPO injections
* Maintains red cell mass

Bone mass maintenance
* Vitamin D supplementation
* Osteoporosis prevention programme

Hypertension control
* Renin-angiotensin system inactive
* Ace inhibitors may have limited use

35
Q

What is the optimal treatment for ESRD?

A

transplant

36
Q

What are problems with transplant?

A

rejection
- acute or chronic

immunosuppression
* increased infection/malignancy risk

osteoporosis risk

37
Q

What are drug interactions that occur withe dentistry after renal transplant?

A

Drug interactions & complications
* Prednisolone
* Cyclosporin

Steroid side effects

Increased Cancer risk
* Be suspicious of oral mucosal lesions

38
Q

What should you do if patient has renal dialysis as a dentist?

A

treat after haemodialysis sessions
Not necessary for PD patients

liase with physicians for drugs

DO NOT use the dialysis shunt! - patient’s lifeline!

39
Q

What pathogen is responsible for UTIs?

A

e coli

40
Q

What are UTI symptoms?

A
  • dysuria
  • urinary frequency
  • cloudy urine
  • offensive smelling urine
  • Supra-pubic pain
41
Q

What can infected urine cause?

A
  • If infected can cause:
  • Cystitis
  • Renal infection
  • Prostate infection

Urethritis can occur in isolation
* Gonococcal

42
Q

How are UTI’s diagnosised?

A

MSSU (urine sample)

bacteria, blood, WBCs indicative of UTI

43
Q

What can cause urinary tract obstructions?

A
  • renal calculi
  • prostatic disease
  • hypertrophy
  • prostatic malignancy
  • urinary tract strictures
  • external compression
44
Q

What are diseases of the prostate?

A

Prostatits
* Inflammation of the prostate

Benign Prostatic Hypertrophy (normal)
* Hyperplasia of the prostate

Prostatic Cancer
* adenocarcinoma

45
Q

Sympotoms of urine outflow obstruction?

A
  • Slow stream
  • Hesitancy
  • Frequency
  • Urgency
  • Nocturia
  • Incomplete voiding
46
Q

Treatment for BPH?

bengin prostatic hypertrophy

A

Initially drug based
* ⍺-blockers drugs to reduce bp
* Anticholinergic
* Diuretics

Surgery – prostatectomy

47
Q

How is prostate cancer screened?

A
  • Prostatic Specific Antigen (PSA) useful for monitoring disease activity in those known to have the disease
  • mpMRI
48
Q

What is treatement of prostatic malignancy?

A
  • Surgery – radical prostatectomy
  • Radiotherapy
  • Hormone treatment
  • Antiandrogens & LHRH analogues
49
Q

What are the stone types of renal calculi and how are they treated?

A
  • calcium and oxalate (radiopaque)
  • uric acid (not radiopaque)
  • treat with LITHOTRYPSY

2 - Diseases Of The Human System (19 decks)

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