Renal medicine Flashcards
What does the membrane with holes in it in the glomerulus prevent?
- Prevent cells and proteins from going into urine
- When find cells or proteins in the urine usually means there is an infection
What is polyuria?
- Pee too much
- Production of abnormally large volumes of dilute urine
What is dysuria?
- Pain when peeing
What is haematuria?
Passing blood in pee
What is proteinuria?
- Protein in your pee
should not happen when the glomerulus is working properly
What is uraemia?
- When waste products that should be excreted by the kidney are not and start to accumulate in the blood
What are the 3 ways of measuring renal function?
- serum UREA
- Serum CREATININE
- 24hr urine collection
You can measure serum urea levels to measure renal function as it will rise. What can this also rise with?
Dehydration
Is measuring serum creatinine for measuring renal function a good general guide to renal function?
- Yes
24hr urine collection is the best measure for renal function. What does this measure?
Creatinine clearance
What functions are lost in renal failure? (4 points)
- 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)
What is acute renal failure?
- Rapid loss of renal function
- Usually over hours or days
What is acute renal failure usually caused by?
- Infection, trauma or damage to the kidneys
- Can happen because medicines are toxic to kidney or damage causes blockage of the renal system
What is chronic renal failure?
- Gradual loss of renal function
- Usually happens over many years
What 3 categories is renal failure put into?
- Pre-renal
- Renal
- Post-renal
What are causes of pre-renal disease?
- Hypoperfusion of the kidney (shock, renal artery or aorta disease)
What does hypo-perfusion mean?
An inadequate supply of blood to an organ or extremity
What are renal causes renal failure? (4 points)
- Diseases of the kidney itself
- Chronic disease, Drug damage, trauma, Rhabdomyolysis
What is Rhabdomyolysis?
A breakdown of skeletal muscle due to direct or indirect injury
How can Rhabdomyolysis cause kidney damage?
Muscle breakdown causes the release of myoglobin into the blood stream. Myoglobin is the protein that stored oxygen in your muscles. If you have too much myoglobin in your blood, it can cause kidney damage
What is the cause of post-renal kidney failure?
Renal flow obstruction.
- If can’t pee out urin e then can’t process any more
What causes pre-renal, renal failure?
Sudden and severe drop in BP (shock) or interruption of blood flow to the kidneys from severe injury or illness
What causes intra-renal, renal failure?
Direct damage to the kidneys by inflammation, toxins, drugs, infection or reduced blood supply
What causes post-renal, renal failure?
Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumour or injury
Acute renal failure is a rapid loss of renal function. What would the creatinine levels be in acute renal failure?
- > 200umol/L of creatinine
What are the normal levels of creatinine in the body?
About 80umol/L
In acute renal failure the patient is Anuric initially with volume overload. What does this mean?
- Anuric = no urine
- Volume overload = fluid will accumulate as you are not removing it from the body
What are common signs/symptoms of acute renal failure? (4 points)
- Ankle oedema (if ambulatory), sacral oedema (if bed bound)
- Pulmonary oedema & breathlessness
- Raised jugular venous pressure
- Weight gain (because retaining fluid)
What does ambulatory mean?
- Related to or adapted for walking
What does acute renal failure eventually progress to?
- Gradually progresses to polyuria (excess production of dilute urine)
Acute renal failure can cause the development of Hyperkalaemia. What is this and what can it lead to?
- High levels of potassium
- Too much potassium makes nerves too excitable or completely unexcitable
- Can get a loss of cardiac rhythm which can lead to cardiac arrest
Acute renal failure can lead to the development of uraemia and acidosis. What does this mean?
- High level and low bicarbonate
- (increased respiratory excretion of CO2 - raised respiratory rate can help maintain acid base balance more)
Is acute renal failure usually a pre, renal or post renal cause?
Usually a PRE-RENAL cause
Is acute renal failure reversible with time?
It usually is
What can be done to give renal support for acute renal failure until recover? (2 points)
- Dialysis
- Nutrition
Is primary chronic renal failure common or rare?
Rare
What are common causes of primary chronic renal failure? (2 points)
- Glomerulonephritis
- Polycystic kidney disease
What is glomerulonephritis?
Acute inflammation of the kidney, typically caused by an immune response
What is polycystic kidney disease?
Causes numerous cysts to grow in the kidneys. These cysts are filled with fluid. If too many cysts grow or if they get too big, the kidneys cam become damaged. PKD cysts can slowly replace much of the kidneys, reducing kidney function and leading to kidney failure
What is the most common cause of secondary chronic renal failure?
Diabetes
What are the main causes of secondary chronic renal failure? (5 points)
- Diabetes (30%)
- Hypertension (20%)
- Drug therapy
- Vasculitis
- Renal artery disease/aorta disease
How can you identify glomerulonephritis?
- The presence of haematuria and proteinuria
- This is the presence of RBC’s and protein in the blood
What can glomerulonephritis gradually progress to? (2 points)
- Hypertension
- Chronic renal failure
What are possible complications of glomerulonephritis? (3 points)
- Excessive loss of protein in the urine (>3g in 24hrs)
- Loss of plasma oncotic pressure
- Tissue swelling (oedema)
What is hypoalbuminemia?
When you don’t have enough of the protein albumin in the bloodstream
When someone has nephrotic syndrome they are in a Hypercoagulable state. what does this mean? (2 points)
- Loss of clotting factors - AT3 deficiency
- Dehydration raises other coagulation concentrations
What type of drugs cause renal disease? (2 points)
- NSAID’s
- Nephrotoxic drugs
How do NSAID’s cause renal disease? (2 points)
- Inhibit glomerular blood flow
- Cause interstitial nephritis
What is an example of a nephrotoxic drug?
- Cyclosporin
- An immunosuppressive drug used to prevent the rejection of grafts and transplants
Renal vascular disease causes reduced blood flow to the kidneys. How is this done? (2 points)
- Atheroma of the renal artery/aorta
- Hypertension - narrowing of the renal artery
Renal vascular disease causes microangiopathy. What is this?
- Immune reaction causing small blood vessel damage, RBC damage and thrombosis
- This is associated with E.coli
What is microangiopathy associated with?
E.coli
What are examples of things that can cause immune mediate renal damage? (3 points)
- Multiple myeloma
- Goodpasture’s syndrome
- Vasculitis
How do multiple myelomas cause renal damage?
- Excess light chain production ‘clogs’ kidneys (tubular nephritis results)
How does Goodpasture’s syndrome cause renal damage?
- Infection will produce antibody which will also damage the kidney
- Anti-glomerular basement membrane antibody (anti-gbm)
What is the cause of polycystic kidney disease?
A gene mutation (PKD1, 2 or 3)
- This can be inherited (AD or AR) or spontaneous
Polycystic kidney disease causes multiple cysts in the renal parenchyma. What does this do to the kidney? (3 points)
- Enlarged kidney
- Progressive destruction of normal kidney
- Gradual renal failure
What is the estimated glomerular filtration rate and creatinine levels in someone with end stage renal disease?
eGFR = <15ml/min
Creatinine = 800-1000umol/L
What does the time taken for someone to develop end stage renal disease depend on? (2 points)
- The underlying cause
- Modifying factors
What would the description be of someone in kidney damage stage 1, and what would their GFR be?
- Normal or minimal kidney damage with normal GFR
- GFR = 90+
What would the description be of someone in kidney damage stage 2, and what would their GFR be?
- Mild decrease in GFR
- GFR = 60-89
What would the description be of someone in kidney damage stage 3, and what would their GFR be?
- Moderate decrease in GFR
- GFR = 30-59
What would the description be of someone in kidney damage stage 4, and what would their GFR be?
- Severe decrease in GFR
- GFR = 15-29
What would the description be of someone in kidney damage stage 5, and what would their GFR be?
- Kidney failure
- GFR = <15
One way of managing chronic renal failure would be to REDUCE the rate of decline. What could you do for this? (4 points)
- Eliminate nephrotoxic drugs
- Control hypertension
- Control diabetes
- Control vasculitic disease (steroids/other immune suppressant drugs control this)
One way of managing chronic renal failure would be to correct the fluid balance. What could you do for this? (2 points)
- Restrict fluid intake
- Reduce salt, potassium and protein
One way of managing chronic renal failure would be to CORRECT deficiencies. What could you do for this? (2 points)
- Anaemia (erythropoietin)
- Calcium (Vitamin D)
One way of managing chronic renal failure would be to REMOVE the outflow obstruction. What could you do for this? (2 points)
- Renal stones (calculi)
- Prostate enlargement
One way of managing chronic renal failure would be to TREAT the infection. What could you do for this? (1 points)
Treat the chronic renal system infection
What are common signs of chronic renal failure? (3 points)
- Anaemia
- Hypertension (caused by and causes renal failure)
- Renal bone disease (low Ca + high PO4, Hyperparathyroidism, Osteomalacia)
What are common symptoms of chronic renal failure? (5 points)
- Insidious (gradual and subtle)
- Polyuria
- Nocturia
- Tired and weak
- Nausea
What does nocturia mean?
- Urination at night - often excessive
Is renal replacement therapy a cure for renal disease?
- No, will always have a health deficit because own kidneys don’t work
What are 2 examples of renal malignancy’s?
- Renal cell carcinoma
- Transitional cell carcinoma
What is a renal cell carcinoma?
- A renal tubular cell tumour
How can you identify a renal cell carcinoma? (2 points)
- Absominal mass
- Haematuria
What 2 things make you more susceptible to getting a renal cell carcinoma?
- Commoner in men
- Commoner in smokers
What 2 things can renal cell carcinoma cause?
- Hypertension (renin)
- Polycythaemia (EPO)
What is polycythaemia?
A rare blood cancer in which bone marrow produces too many RBC’s
Where does a transitional cell carcinoma usually effect?
- Usually bladder - ureter/kidney possible
Do transitional cell carcinomas cause haematuria?
- Yes - often asymptomatic
Does renal disease usually have many oral complications?
- No, few direct oral problems
What do you need to be careful of when a patient has renal disease?
CARE with prescribing
- Check all drugs with renal physician
- Avoid NSAID’s, some tetracyclines
- Reduce dose of most others
What is a possible dental complication of renal disease in children?
Growth may be slow in children
- Tooth eruption may be delayed
What are secondary oral effects of anaemia caused by chronic renal disease? (2 points)
- Oral ulceration
- ‘dysaesthesias’ - painful mucosa and tongue
Chronic renal failure can lead to white patches in the mouth, what is this?
Uraemic stomatitis
What are the dental complications of renal disease? (4 points)
- Oral opportunistic infections
- Dry mouth & taste disturbance
- Bleeding tendencies
- Renal osteodystrophy
What are common oral opportunistic infections caused by renal disease?
- Fungal and viral infections/reactivations
- Prone to post-op infections
What causes dry mouth and taste disturbances in renal disease?
Fluid restriction and electrolyte disturbance
What causes bleeding tendencies in renal disease?
Platelet dysfunction
What causes renal osteodystrophy in renal disease?
- Lamina dura lost
- Bony radiolucencies
- Secondary hyperparathyroidism increases osteoclast activity
What is renal osteodystrophy?
A bone disease that occurs when your kidney’s fail to maintain the proper levels of calcium and phosphorus in your blood
