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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
How is a patient with acute renal failure managed until recovery?
Renal support until recovered: -dialysis -nutrition
26
What is dialysis?
Artificial replacement of some aspects of renal function
27
What are the 2 types of chronic renal failure?
Primary (rare) - issue with the actual kidney itself Secondary - kidney problem as a result of other medical problems
28
What can cause primary chronic renal failure?
-glomerulonephritis -Polycystic Kidney Disease
29
What can cause secondary chronic renal failure?
-diabetes (biggest cause) -hypertension -drug therapy -vasculitis -renal artery disease/aorta disease
30
What is Glomerulonephritis?
Inflammation of the Glomerulus
31
What signs/symptoms will be seen with glomerulonephritis?
-haematuria/proteinuria -otherwise healthy individual
32
How do proteins manage to pass into the urine in glomerulonephritis?
glomerulus inflamed so filtration slits get bigger so protein and blood can get through
33
Glomerulonephritis results in a gradual progression to what?
-hypertension -chronic renal failure
34
What is nephrotic syndrome a complication of?
Glomerulonephritis
35
What happens in nephrotic syndrome with relation to glomerulonephritis?
-excessive loss of protein in the urine - 3g in 24hours (hypoalbuminemia) -loss of plasma oncotic pressure -tissue swelling (oedema)
36
What state can someone with nephrotic syndrome be in?
-Hypercoagulable state
37
What is meant by a hypercoagulable state?
-loss of clotting factors - AT3 deficiency -dehydration raises other coagulation factor concentrations
38
What drugs should be avoided in renal disease?
-NSAIDS -Nephrotoxic drugs
39
How do NSAIDS affect the renal system?
-inhibit glomerular blood flow -cause interstitial nephritis
40
What is an example of a nephrotoxic drug?
cyclosporin
41
What happens in renal vascular disease?
-reduced blood flow to the kidney -microangiopathy (damage to BV on microscopic level)
42
What can cause the reduced blood flow to the kidney in renal vascular disease?
-atheroma of renal artery/aorta -hypertension - narrowing of the renal artery
43
What is microangiopathy/what causes it?
-immune reaction causing small blood vessel damage, RBC damage and thrombosis -associated with E Coli
44
Why is the ?? prone to atherosclerosis?
-comes off from the ?? artery at a 90 degree angle
45
What are some examples of immune mediated renal damage?
-multiple myeloma -Goodpasture's syndrome -vasculitis
46
What is multiple myeloma and how does it affect kidneys?
-plasma cell tumour -excess light chain production 'clogs' kidney and tubular nephritis results
47
What is Goodpasture's syndrome?
Anti-glomerular basement membrane antibody and causes damage to kidney
48
What is vasculitis?
Inflammation of BV and it clogs up and shuts down - if happens to kidney = kidney prob
49
What is polycystic kidney disease?
Multiple cysts in the renal parenchyma
50
What happens in Polycystic Kidney disease?
-enlarged kidney -progressive destruction of normal kidney -gradual renal failure
51
What causes polycystic kidney disease?
-gene mutation -can be inherited or spontaneous
52
What determines what is end stage renal disease?
When: -eGFR \<15ml/min (is normally \>60) -creatinine levels are 800-1000umol/L (normal - 80) - no useable renal function left
53
The time taken for end stage renal disease to progress depends on what?
-underlying cause -modifying factors
54
look at eGFR
missed
55
How is chronic renal failure managed?
-reduce the rate of decline -correct fluid balance -correct deficiencies -remove outflow obstructions -treat infections
56
How can the rate of decline in chronic renal failure be reduced?
-eliminate nephrotoxic drugs (e.g. NSAIDS) -control hypertension -control diabetes -control vcasculitic disease (steroids/otehr immun suppressant drugs)
57
How can fluid balance be corrected in chronic renal disease?
-restrict fluid intake -restrict salt, potassium, protein
58
What deficiencies might you want to correct in chronic renal failure?
-anaemia (erythropoietin) -calcium (vit D)
59
What outflow obstructions might need to be removed in chronic renal failure?
-renal stones -prostate enlargement
60
What infections might need to be treated in chronic renal failure?
-chronic renal system infection
61
What are the signs of chronic renal failure?
- anaemia - hypertension -renal bone disease( low Ca & high PO4, hyperparathyroidism, osteomalacia)
62
What are the symptoms of chronic renal failure?
-insidious -polyuria -nocturia -tires and weak -nausea non-specific symptoms that happen gradually (P may put it down to being old)
63
What is renal replacement therapy?
Replacement of the functions of the kidney -NOT A CURE
64
How does renal disease impact dentistry?
-few direct oral problems -general health may dictate treatment timing -take care with prescribing
65
What should be done when prescribing drugs for a patient with renal disease?
-check all drugs with physician -avoid NSAID, some tetracyclines -reduce the dose of most other drugs
66
What effects does chronic renal failure have on a patients oral health?
-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
What oral problems can occur as a result of renal disease?
-oral opportunistic infections -dry mouth and taste disturbance -bleeding tendencies -renal osteodystrophy
68
Describe the oral opportunistic infections that can be present due to renal disease.
-fungal and viral infections/reactivations -prone to post-op infections
69
Why might a renal disease patient have dry mouth and taste disturbance?
-fluid restriction and electrolyte disturbance
70
Why do renal disease patients have bleeding tendencies?
-PLatelet dysfunction
71
renal osteodystrophy
bone disorder ??sduvnfhsvgbhjksnc look at slides

Renal Medicine (BDS1-BDS2) (2 decks)

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