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Renal Medicine (BDS1-BDS2) > Renal Medicine (BDS2 - Dr Crighton) > Flashcards

Renal Medicine (BDS2 - Dr Crighton) Flashcards

1
Q

What is polyuria?

A

Excessive urination

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2
Q

What is dysuria?

A

pain on urination

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3
Q

What is haematuria?

A

Blood in urine

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4
Q

What is proteinuria?

A

Protein in urine (shouldn’t have this if the glomerulus is working properly - filtration slits)

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5
Q

What is uraemia?

A

Things that should have been excreted by the kidneys (urea) accumulating in the blood

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6
Q

What are the 3 ways that renal function can be measured?

A

-serum urea -serum creatinine -24hr urine collection

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7
Q

How does serum urea measure renal function?

A

-urea stays at a constant level within the blood but effects such as dehydration will see an ‘increase’ in the serum urea concentration (less water to dilute it)

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8
Q

Describe how serum creatinine help measure renal function?

A

-should be a low level -will rise if kidneys not working -good general guide to renal function

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9
Q

Describe how 24hr urine collection measures renal function.

A

Measures the creatinine clearance in urine

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10
Q

What is the best way to measure renal function?

A

24 hour urine collection (followed by serum creatinine)

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11
Q

What components of renal function are lost in renal failure?

A

-loss of renal excretory function -loss of water and electrolyte balance -loss of acid base balance -loss of renal endocrine function

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12
Q

missed parts

A

missed

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13
Q

What is acute renal failure?

A

Rapid loss of renal functions usually over hours or days

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14
Q

What is chronic renal failure?

A

-gradual loss of renal function -usually over many years

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15
Q

What can acute renal failure be due to?

A

-infection/trauma/damage to kidneys -medicines can be toxic to the kidneys

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16
Q

What are the 3 categories that the causes of renal function can come under?

A

-pre-renal -renal -post renal

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17
Q

What can be a pre-renal cause of renal fusion?

A

Hypoperfusion of the kidney (reduced blood flow)

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18
Q

What can cause hypoperfusion of the kidney?

A

-shock -renal artery or aorta disease

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19
Q

What are some possible renal causes that can lead to renal failure?

A

-chronic disease -drug damage -trauma -Rhabdomyolysis (break down of proteins in the muscles and blocking the inside of the glomerulus)

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20
Q

What is a possible post-renal cause of renal failure?

A

-renal outflow obstruction (cant urinate)

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21
Q

urinate)
How will the creatinine levels differ in acute renal failure?

A

-they will go high to >200umol/L

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22
Q

missed slides

A

missed

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23
Q

What normally causes acute renal failure ?

A

usually a pre-renal cause (catastrophic BP drop)

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24
Q

Is acute renal failure reversible?

A

Usually reversible with time

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25
Q

How is a patient with acute renal failure managed until recovery?

A

Renal support until recovered: -dialysis -nutrition

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26
Q

What is dialysis?

A

Artificial replacement of some aspects of renal function

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27
Q

What are the 2 types of chronic renal failure?

A

Primary (rare) - issue with the actual kidney itself
Secondary - kidney problem as a result of other medical problems

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28
Q

What can cause primary chronic renal failure?

A

-glomerulonephritis -Polycystic Kidney Disease

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29
Q

What can cause secondary chronic renal failure?

A

-diabetes (biggest cause) -hypertension -drug therapy -vasculitis -renal artery disease/aorta disease

30
Q

What is Glomerulonephritis?

A

Inflammation of the Glomerulus

31
Q

What signs/symptoms will be seen with glomerulonephritis?

A

-haematuria/proteinuria -otherwise healthy individual

32
Q

How do proteins manage to pass into the urine in glomerulonephritis?

A

glomerulus inflamed so filtration slits get bigger so protein and blood can get through

33
Q

Glomerulonephritis results in a gradual progression to what?

A

-hypertension -chronic renal failure

34
Q

What is nephrotic syndrome a complication of?

A

Glomerulonephritis

35
Q

What happens in nephrotic syndrome with relation to glomerulonephritis?

A

-excessive loss of protein in the urine - 3g in 24hours (hypoalbuminemia) -loss of plasma oncotic pressure -tissue swelling (oedema)

36
Q

What state can someone with nephrotic syndrome be in?

A

-Hypercoagulable state

37
Q

What is meant by a hypercoagulable state?

A

-loss of clotting factors - AT3 deficiency -dehydration raises other coagulation factor concentrations

38
Q

What drugs should be avoided in renal disease?

A

-NSAIDS -Nephrotoxic drugs

39
Q

How do NSAIDS affect the renal system?

A

-inhibit glomerular blood flow -cause interstitial nephritis

40
Q

What is an example of a nephrotoxic drug?

A

cyclosporin

41
Q

What happens in renal vascular disease?

A

-reduced blood flow to the kidney -microangiopathy (damage to BV on microscopic level)

42
Q

What can cause the reduced blood flow to the kidney in renal vascular disease?

A

-atheroma of renal artery/aorta -hypertension - narrowing of the renal artery

43
Q

What is microangiopathy/what causes it?

A

-immune reaction causing small blood vessel damage, RBC damage and thrombosis -associated with E Coli

44
Q

Why is the ?? prone to atherosclerosis?

A

-comes off from the ?? artery at a 90 degree angle

45
Q

What are some examples of immune mediated renal damage?

A

-multiple myeloma -Goodpasture’s syndrome -vasculitis

46
Q

What is multiple myeloma and how does it affect kidneys?

A

-plasma cell tumour -excess light chain production ‘clogs’ kidney and tubular nephritis results

47
Q

What is Goodpasture’s syndrome?

A

Anti-glomerular basement membrane antibody and causes damage to kidney

48
Q

What is vasculitis?

A

Inflammation of BV and it clogs up and shuts down - if happens to kidney = kidney prob

49
Q

What is polycystic kidney disease?

A

Multiple cysts in the renal parenchyma

50
Q

What happens in Polycystic Kidney disease?

A

-enlarged kidney -progressive destruction of normal kidney -gradual renal failure

51
Q

What causes polycystic kidney disease?

A

-gene mutation -can be inherited or spontaneous

52
Q

What determines what is end stage renal disease?

A

When: -eGFR <15ml/min (is normally >60) -creatinine levels are 800-1000umol/L (normal - 80) - no useable renal function left

53
Q

The time taken for end stage renal disease to progress depends on what?

A

-underlying cause -modifying factors

54
Q

look at eGFR

A

missed

55
Q

How is chronic renal failure managed?

A

-reduce the rate of decline -correct fluid balance -correct deficiencies -remove outflow obstructions -treat infections

56
Q

How can the rate of decline in chronic renal failure be reduced?

A

-eliminate nephrotoxic drugs (e.g. NSAIDS) -control hypertension -control diabetes -control vcasculitic disease (steroids/otehr immun suppressant drugs)

57
Q

How can fluid balance be corrected in chronic renal disease?

A

-restrict fluid intake -restrict salt, potassium, protein

58
Q

What deficiencies might you want to correct in chronic renal failure?

A

-anaemia (erythropoietin) -calcium (vit D)

59
Q

What outflow obstructions might need to be removed in chronic renal failure?

A

-renal stones -prostate enlargement

60
Q

What infections might need to be treated in chronic renal failure?

A

-chronic renal system infection

61
Q

What are the signs of chronic renal failure?

A
  • anaemia
  • hypertension -renal bone disease( low Ca & high PO4, hyperparathyroidism, osteomalacia)
62
Q

What are the symptoms of chronic renal failure?

A

-insidious -polyuria -nocturia -tires and weak -nausea
non-specific symptoms that happen gradually (P may put it down to being old)

63
Q

What is renal replacement therapy?

A

Replacement of the functions of the kidney -NOT A CURE

64
Q

How does renal disease impact dentistry?

A

-few direct oral problems -general health may dictate treatment timing -take care with prescribing

65
Q

What should be done when prescribing drugs for a patient with renal disease?

A

-check all drugs with physician -avoid NSAID, some tetracyclines -reduce the dose of most other drugs

66
Q

What effects does chronic renal failure have on a patients oral health?

A

-growth may be slow in children so tooth eruption can be delayed -secondary effects of anaemia: oral ulceration and dysaesthesias (painful mucosa and tongue) -whitw patches: uraemic stomatitis

67
Q

What oral problems can occur as a result of renal disease?

A

-oral opportunistic infections -dry mouth and taste disturbance -bleeding tendencies -renal osteodystrophy

68
Q

Describe the oral opportunistic infections that can be present due to renal disease.

A

-fungal and viral infections/reactivations -prone to post-op infections

69
Q

Why might a renal disease patient have dry mouth and taste disturbance?

A

-fluid restriction and electrolyte disturbance

70
Q

Why do renal disease patients have bleeding tendencies?

A

-PLatelet dysfunction

71
Q

renal osteodystrophy

A

bone disorder ??sduvnfhsvgbhjksnc look at slides

Renal Medicine (BDS1-BDS2) (2 decks)

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