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BDS2 BAMS Renal > Renal Overview > Flashcards

Renal Overview Flashcards

1
Q

What is polyuria

A

pee too much

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2
Q

What is dysuria

A

pain on passing urine

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3
Q

What is haemapuria

A

passing blood in urine

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4
Q

What is proteinuria

A

protein in urine

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5
Q

What is uremia

A

when waste products should be excreted by the kidney are starting to accumulate in the blood

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6
Q

How is renal function measured

A

serum urea
serum creatine
24 hour urine collection

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7
Q

How is serum urea used to measure renal function

A

o goes up in renal dysfunction but also rises with dehydration meaning it isn’t a good indicator

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8
Q

How is serum creatine used to measure renal function

A

o good general guide to renal function
o should be relatively low
o if kidney is not working then it will rise

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9
Q

How is urine collection used to measure renal function

A

o creatine clearance – best measure

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10
Q

What are the consequences of renal failure

A 
loss of renal excretory function 
loss of water and electrolyte balance 
loss of acid base balance
loss of renal endocrine function 
calcium metabolism 
renin secretion
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11
Q

Why is there a loss of water and electrolyte balance in renal failure

A

o unable to modify electrolytes within the collecting duct and so losing more than you should do

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12
Q

Why is there a loss of acid base balance in renal failure

A

o losing hydrogen ions
o this can upset the acid base balance
o can be compensated by ventilation (breathing more acid)

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13
Q

What renal endocrine functions are lost

A

erythropoietin
calcium metabolism
renin secretion

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14
Q

What are the two types of renal failure

A

acute and chronic

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15
Q

What is acute renal failure

A

o happens suddenly
o often due to infection, trauma or damage to the kidneys
o rapid loss of renal function
o usually over hours or days

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16
Q

What is chronic renal failure

A

o gradual loss of renal function

o usually over many years

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17
Q

What can causes of renal failure be split into

A

prerenal
renal
post renal

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18
Q

What are the prerenal causes

A

hypoperfusion of the kidney
shock
renal artery or aorta diseases

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19
Q

What are the renal causes

A

chronic disease
drug damage
trauma
rhabdomyolysis

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20
Q

What is rhabdomyolysis

A

o protein taken from muscle round to kidney blocking glomerulus

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21
Q

What are post renal causes

A

 renal outflow obstruction

o stones

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22
Q

How is acute renal failure defined

A

It is the rapid loss of renal function resulting in a Creatine > 200umol/L. The normal is usually 80.

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23
Q

How does acute renal failure present

A

anuric initially with volume overload
gradually progresses to polyuria
development of hyperkalaemia
development of uremia and acidosis

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24
Q

What does anuric and volume overload result in

A

 ankle oedema (if ambulatory), sacral oedema (if bed bound)
 pulmonary oedema and breathlessness
 raised jugular venous pressure (JVP)
 weight gain

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25
What does hyperkalaemia result in
can lead to cardiac arrest as it alters the nerves excitability
26
What does the development of uremia and acidosis result in
 high urea  low bicarbonate  increased respiratory excretion of CO2 o raised respiratory rate
27
What are the causes of acute renal failure
usually prerenal
28
Is acute renal failure reversible
Usually reversible with time Renal support is required until recovery  dialysis  nutrition
29
What are the primary causes of chronic renal failure
 glomerulonephritis |  polycystic kidney disease
30
What are the secondary causes of chronic renal failure
```  diabetes (30%)  hypertension (20%)  drug therapy  vasculitis  renal artery disease/aorta disease ```
31
What is seen in glomerulonephritis
Haematuria/proteinuria in an otherwise healthy individual There will be a gradual progression to hypertension and chronic renal failure due to the damage to the glomerulus system meaning that you will not be producing angiotensin and renin
32
What is nephrotic syndrome due to
Complications of glomerulonephritis
33
What happens in nephrotic syndrome
Complications of glomerulonephritis:  excessive loss of protein in the urine  loss of plasma oncotic pressure  tissue swelling (oedema) due to the lack of oncotic pressure to draw the fluid back into the vessels hypercoagulable state
34
Why is there a hypercoaglulable state in glomerulonephritis
antithrombin is lost in the urine, leading to a higher activity of Factor II and Factor X and in increased tendency to thrombosis.
35
Why are NSAIDs bad for renal disease
NSAIDs inhibit glomerular blood flow and cause interstitial nephritis due to their inhibition of prostaglandins They should be avoided in renal disease if possible.
36
What other drugs can result in renal disease
Nephrotoxic drugs can also result in renal disease e.g cyclosporin.
37
What are different renal vascular diseases
reduced blood flow to kidney | microangiopathy
38
What is reduced BF to kidney due to
 atheroma of renal artery and aorta |  hypertension – narrowing of renal artery
39
What is micrangiopathy
 immune reaction causing small blood vessel damage, RBC damage and thrombosis o E.Coli 0157 association
40
What is polycystic kidney disease due to
```  gene mutation (PKD 1,2 or 3) o inherited (AD or AR) or spontaneous ```
41
what can polycystic kidney disease lead to
o enlarged kidney o progressive destruction of normal kidney o gradual renal failure
42
What is end stage renal disease defined by
 eGFR <15ml/min |  creatine 800-1000umol/L
43
What is the time taken for end stage renal disease dependent on
 underlying cause |  modifying factors
44
What is the grading for kidney disease
The kidney damage can be graded | 1 is normal and 5 is kidney failure
45
How is chronic renal failure managed
``` reduce rate of decline correct fluid balance correct deficiencies remove outflow obstruction treat infection ```
46
how do you reduce rate of decline of chronic renal failure
```  eliminate the nephrotoxic drugs  control hypertension  control diabetes  control vasculitis disease o steroids/other immune suppressant drugs ```
47
How do you correct fluid balance
 restrict fluid intake |  restrict salt, potassium and protein
48
How do you correct deficiencies
 anaemia (erythropoietin) |  calcium (vitamin D)
49
How do you remove outflow obstruction
 renal stones (calculi) |  prostate enlargement
50
What infections do you treat when managing chronic renal failure
 chronic renal system infection
51
What are the signs of chronic renal failure
 anaemia  hypertension  renal bone disease
52
What are the causes of renal bone disease in chronic renal failure
o low Ca, high PO4 o hyperparathyroidism o osteomalacia
53
What are the symptoms of renal failure
```  insidious o may be a few  polyuria  nocturia  tired and weak  nausea ```
54
What is renal replacement therapy
Have to replace the functions of the kidney but it is not a cure as the kidneys still do not work
55
When should be care taken in dentistry regarding renal disease
Care should be taken with prescribing  check all drugs with renal physician  avoid NSAIDs and tetracyclines  reduce dose of most others
56
What is the effect of renal disease in children
Growth may be slow in children and tooth eruption may be delayed
57
What are the secondary effects of anaemia
 oral ulceration |  ‘dysaesthesias’ – painful mucosa and tongue
58
Why may white patches be seen in the mouth
 uraemic stomatitis
59
What may be seen in patients with renal disease
oral opportunistic infections dry mouth and taste disturbances bleeding tendencies renal osteodystorphy
60
Why may you see a dry mouth and taste disturbance
o fluid restriction and electrolyte disturbance
61
What are the oral opportunistic infections
o fungal and viral infections/reactivations | o prone to post-op infections
62
Why is there bleeding tendencies
o platelet dysfunction
63
What will be seen in the mouth regarding renal osteodystrophy
o lamina dura lost o bony radiolucency  secondary hyperparathyroidism increases osteoclast activity

BDS2 BAMS Renal (3 decks)

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