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Renal Medicine > Renal Medicine > Flashcards

Renal Medicine Flashcards

1
Q

What does a urine sample containing cells/protein indicate?

A

Disease of the glomerulus

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2
Q

What does a lack of ADH indicate?

A

Diabetes Insipidus (peeing a lot)

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3
Q

What is Diabetes Insipidus

A

Large amount of urine produced and feels thirsty

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4
Q

Name a kidney function

A

Lots of fluid reabsorption within the collecting tubules

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5
Q

Define polyuria

A

Excessive/abnormally large production/passage of urine

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6
Q

Define dysuria

A

Painful/difficult urination

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7
Q

Define haematuria

A

The presence of blood in urine

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8
Q

Define proteinuria

A

The presence of excess proteins in the urine (which often causes foamy urine)

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9
Q

Define uraemia

A

A raised level of urea in the blood + other nitrogenous waste compounds that are eliminated by kidneys

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10
Q

What are 3 methods used to measure renal function?

A
  1. Serum Urea
  2. Serum creatinine
  3. 24hr urine collection
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11
Q

Which one of the renal function tests is the best?

A

24hr urine collection

- Creatinine clearance (so best measure)

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12
Q

When do serum urea levels rise?

A

Rise with dehydration

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13
Q

What does renal failure lead to? (4)

A
  1. Loss of renal excretory function
  2. Loss of water + electrolyte balance
  3. Loss of acid base balance
  4. Loss of renal endocrine function
    - Erythropoietin
    - Ca+ metabolism
    - Renin secretion
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14
Q

How does loss of water/electrolyte balance affect H2O/Na+ levels?

A

As if you can’t concentrate or modify the electrolytes within the collecting duct system you might lose more H2O/Na+ than you should

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15
Q

Function of erythropoietin?

A
  • Controls ability to make RBCs

- If there’s no functioning kidney the bone marrow won’t be asked to make RBCs

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16
Q

Where does Ca metabolism occur?

A

Kidneys

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17
Q

Compare:
Acute renal failure
Chronic renal failure

A

ACUTE RENAL FAILURE:

  • Rapid loss of renal function
  • Usually over hours/days

CHRONIC RENAL FAILURE:

  • Gradual loss of renal function
  • Usually over many years
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18
Q

List causes of renal failure (3)

A
  1. Pre-renal
  2. Renal
  3. Post renal
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19
Q

How does pre-renal failure occur?

A
  1. Hypoperfusion of the kidney (a reduced amount of blood flow)
  2. Shock
  3. Renal artery/aorta disease
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20
Q

How does renal failure (disease of kidney itself) occur?

A

Direct damage to kidneys by:

  1. Chronic disease
  2. Drug damage
  3. Trauma
  4. Rhabdomyolysis
21
Q

Define rhabdomyolysis

A

Breakdown of damaged skeletal muscle

22
Q

How does post renal failure occur?

A

Renal outflow obstruction

23
Q

How does renal outflow obstruction present?

A

Can be stones or prostate blockage of urinal tract

24
Q

Creatinine levels that indicate acute renal failure

A

Creatinine > 200umol/L

25
Q

What clinical problems does an acute renal failure cause? (5)

A 
Anuric initially:
1. Ankle oedema (if ambulatory)
Sacral oedema (if bed bound)
2. Pulmonary oedema + breathlessness 
3. Raised jugular venous pressure 
4. Weight Gain

Gradually progresses to polyuria

26
Q

Acute renal failure can lead to Hyperkalaemia (high K+) why is this a problem?

A

Can lead to cardiac arrest

27
Q

Acute renal failure can lead to Uraemia + Acidosis, why is this a problem? (3)

A
  1. High urea
  2. Low bicarbonate
  3. Increased respiratory excretion of CO2
    - Raised respiratory rate
28
Q

What is the usual cause for acute renal failure? (2)

A
  • Pre-renal cause

- Usually reversible with time

29
Q

What type of chronic renal failure is rare?

A

Primary

30
Q

Causes of primary chronic renal failure (2)

A
  1. Glomerulonephritis

2. Polycystic kidney disease

31
Q

Causes of secondary chronic renal failure (5)

A
  1. Diabetes
  2. Hypertension
  3. Drug therapy
  4. Vasculitis - inflammation of bv’s
  5. Renal artery disease/aorta disease
32
Q

What is glomerulonephritis?

A

Inflammation of the glomeruli, which are structures in your kidneys that are made up of tiny blood vessels

33
Q

Name a symptom for glomerulonephritis?

A

Hypertension

34
Q

Define nephrotic syndrome

A

Excess loss of protein in the urine >3g

35
Q

Function of NSAIDs (2)

A
  • Inhibit glomerular blood flow

- Cause interstitial nephritis (spaces between kidney tubules become inflamed, so they don’t filter properly)

36
Q

What does renal vascular disease cause?

A
  1. Reduced blood flow to the kidney
    - Atheroma of renal artery/aorta
    - Hypertension (narrowing of renal artery)
  2. Microangiopathy
    - when the capillaries becomes so thick that they bleed and they leak proteins out
37
Q

What does microangiopathy lead to?

A
  1. Immune reaction causing small blood vessel damage
  2. RBC damage
  3. Thrombosis
38
Q

Examples of immune mediated renal damage (3)

A
  1. Multiple myeloma
  2. Good pastures syndrome
  3. Vasculitis
  4. Polycystic kidney disease
39
Q

Where are cysts present in polycystic kidney disease? (3)

A

Multiple cysts in the renal parenchyma

  • Enlarged kidney
  • Progressive destruction of normal kidney
  • Gradual renal failure
40
Q

Indications of end stage renal disease

A

eGFR < 15ml/min

Creatininine 800-1000umol/L

41
Q

How is chronic renal failure managed? (4)

A
  1. Reduce the rate of decline
    - Eliminate nephrotoxic drugs
    - Control hypertension
    - Control diabetes
    - Control vasculitic disease
  2. Correct fluid balance
    - Restrict fluid intake
    - Restrict salt, potassium, protein
  3. Correct deficiencies
    - Anaemia (erythropoietin)
    - Calcium (vitD)
  4. Remove outflow obstruction
    - Renal stones calculi
    - Prostate enlargement
42
Q

List signs of chronic renal failure (3)

A
  1. Anaemia
  2. Hypertension
  3. Renal bone disease
    - Low Ca, high PO4
    - Hyperparathyroidism
    - Osteomalacia
43
Q

List symptoms of chronic renal failure (5)

A
  1. Insidious
  2. Polyuria
  3. Nocturia
  4. Tired + weak
  5. Nausea
44
Q

What does renal replacement therapy mean?

A

Replaces functions of the kidney but its not a cure

45
Q

Who is a renal cell carcinoma more present in?

A

Common in men + smokers

46
Q

Where is a transitional cell carcinoma more present?

A
  1. Usually bladder - ureter/kidney possible

2. Haematuria - often asymptomatic

47
Q

When you have a renal disease patient what should you check/consider? (3)

A
  1. Check all drugs with renal physician
  2. Avoid NSAIDs, some tetracyclines
  3. Reduce dose of most others
48
Q

Dentistry and chronic renal failure issues

A
  1. Tooth eruption may be delayed
  2. Secondary effects of anaemia
    - Oral ulceration
    - Dysaesthesias (painful mucosa + tongue)
  3. White patches
    - Uraemia stomatitis
49
Q

Dentistry and renal disease (4)

A
  1. Oral opportunistic infections
    - Fungal and viral infections/reactivations
    - Prone to post-op infections
  2. Dry mouth + taste disturbance
    - Fluid restriction and electrolyte disturbance
  3. Bleeding tendencies
    - Platelet dysfunction
  4. Renal osteodystrophy
    - Lamina dura lost
    - When kidneys fail to maintain proper levels of Ca

Renal Medicine (1 decks)

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