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DMD2 > RENAL SYSTEM > Flashcards

RENAL SYSTEM Flashcards

1
Q

Which of the following is incorrect regarding fluid input and output
A) Approximately 250mL fluid from oxidation of carbohydrates
B) Urine loss of approximately 1500mL
C) Fluid loss in stool of approximately 200mL
D) Fluid input from food approximately 750mL

A

C) Should be approximately 100mL

Fluid loss from sweat is approx 200mL

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2
Q

What are the causes and S+S of hypovolaemia?

A 
•	Causes
o	Blood loss
o	Kidney damage – Insufficient Na+ reabsorption
o	Diuretic drugs
o	Aldosterone deficiency
o	Diarrhea or vomiting
o	Excess sweating
•	Signs and symptoms:
o	Postural hypotension
o	Tachycardia
o	Pale
o	Thirst
o	Dizzy or confused.
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3
Q

What are the causes and S+S of hypervolaemia?

A 
•	Causes: 
o	Excessive isotonic infusion
o	Kidney failure – Insufficient Na+ excretion
o	Heart failure
o	Aldosterone excess
•	Signs and symptoms:
o	Oedema = Fluid escape into ISF
	Reduced oncotic pressure of plasma. 
	Increased hydrostatic pressure in capillaries.
o	High blood pressure (usually chronic) 
o	Weight gain
o	Shortness of breath/pulmonary congestion 
o	High urine output
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4
Q

Which of the following is most correct?
A) The kidney is located anterior to the liver and spleen
B) The kidney is responsible for the storage of Vit D
C) The kidney is located within the abdominal cavity
D) The kidney produces and releases aldosterone

A

C)

A) Located posterior to liver and spleen
B) Does not store but activates Vit D
D) Aldosterone released by adrenal glands

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5
Q

Which of the following is incorrect?
A) The proximal convoluted tubule has a brush border on apical membrane
B) Calcium is mainly reabsorbed in the distal convoluted tubule and cortical collecting duct
C) Blocking the sodium channels in the cortical collecting duct leads to hypokalaemia
D) There is no reabsorption of H2O in the thick ascending limb

A

C) Results in hyperkalaemia

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6
Q

What causes hypernatraemia and what are the S+S?

A

Causes:

  • Chronic renal failure
  • Diabetes insipidus

S+S:

  • Neurological - headache, confusion, seizure
  • Polyuria
  • Polydispsia
  • Thirst
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7
Q 
Dwight is prescribed a diuretic which acts to block ENAC in the CCD. Which diuretic is he prescribed? 
A) Acetazolamide
B) Frusemide
C) Spironolactone
D) Amiloride
A

D)

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8
Q

What are the side effects of frusemide and thiazide?

A

o Side effects for both:
 Hypovolaemia – weakness, muscle cramps, confusion, drowsiness, seizures.
 Hypotension
 Low plasma [Na+] (and neurological symptoms) – confusion, seizures, muscle cramps
 Low plasma [K+] – muscle pain, cardiac arrhythmia (consider LA adrenaline impact), polyuria
 Alkalosis

o Side effects for thiazides:
 High plasma [Ca2+] and [Glucose]
 High plasma [Urea] – Risk of gout

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9
Q

What are the three parts to the filtration barrier?

A
  1. Fenestrated capillary endothelium
  2. Basement membrane
  3. Foot processes (pedicles) and slit diaphragms of podocytes
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10
Q 
Which of the following is incorrect as a preliminary sign of failing kidneys? 
A) Increase in serum creatinine 
B) Increase in serum calcium
C) Decrease in Hb
D) Decrease in active Vit D
A

B) Decrease in serum calcium generally occurs (although this may modulate to normal range as PTH released in response to low Ca)

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11
Q

Explain issues with using creatinine and urea as measurements for renal clearance.

A

Creatinine → Freely filtered AND tubular secretion. Overestimates GFR by 20% due to tubular secretion
Urea → Freely filtered AND tubular reabsorption. Underestimates GFR.

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12
Q

Explain the % of K+ absorption/secretion at the four major points of the nephron.

A
  • PCT → 65% reabsorbed
  • Thick Ascending Limb → 25% reabsorbed
  • Late DCT and Collecting Duct → 20% reabsorbed (low K+) OR 5% secreted (high K+)
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13
Q

Which of the following is true regarding potassium disturbances?
A) Hypokalaemia leads to decrease in membrane excitability
B) Hyperkalaemia leads to increase in membrane excitability
C) Hypokalaemia results in ventricular arrythmias
D) Hyperkalaemia results in tachycardia

A

C)

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14
Q

What is oliguria and what is the most common cause?

A

Oliguria = Decrease in urine output to <500mL per day

Most common cause = Volume depletion

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15
Q

What are the three broad causes of decreased GFR?

A
  1. Pre renal = Reduced perfusion pressure
  2. Renal failure = Decreased glomerulus capillary perm ability/surface area or increased early tubular pressure
  3. Post renal = Increase tubular pressure
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16
Q

Define AKI.

A

Acute Kidney Injury (AKI) = Abrupt decrease in GFR occurring within hours or days, resulting in impaired fluid and electrolyte homeostasis and accumulation of nitrogen waste.

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17
Q

Define AKI.

A

Acute Kidney Injury (AKI) = Abrupt decrease in GFR occurring within hours or days, resulting in impaired fluid and electrolyte homeostasis and accumulation of nitrogen waste.

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18
Q

What causes extracellular oedema?

A
  • Increased water/salt reabsorption in nephrons - Excess ADH or RAAS activation
  • Kidney failure
  • Congestive heart failure
  • Pregnancy
  • Drug induced (e.g. NSAIDS)
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19
Q

What are the four tests for proteinuria?

A
  1. Dipstick test
  2. Protein/Creatinine
  3. Albumin/Creatinine = >2.5mg for women and >3.5mg for men
  4. 24 hour urine collection =
    - <150mg = Normal
    - 150mg - 3.5g = Proteinuria
    - > 3.5g = Nephrotic syndrome
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20
Q

What are three non pathological causes of proteinuria?

A
  • Exercise
  • Fever
  • Orthostatic proteinuria
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21
Q

What are the four mechanisms of proteinuria?

A
  • Glomerular proteinuria
  • Tubular proteinuria
  • Overflow proteinuria
  • Post-renal proteinuria
22
Q

Which of the following is incorrect regarding the consequences of proteinuria?
A) Infection risk increases
B) Higher levels of activated Vit D increases Ca absorption
C) Dyslipidaemia may occur
D) Bleeding risk increases

A

B) Opposite occurs - lower levels of activated vit D leads to hypocalcaemia

23
Q 
On histological examination of a patient with glomerular disease, the following was noted: Sporadic infiltration of IgG in the endothelium and C3 and neutrophil infiltration. Mesangial and endothelial proliferation with subepithelial humps are evident. Which is most likely? 
A) Post-strep glomerulonephritis 
B) IgA nephropathy 
C) Membranous glomerulonephritis
D) Minimal change disease
A

A)

24
Q

What are 3 characteristic symptoms of nephrotic vs nephritic syndrome? Distinguish the the onset (ie. acute vs chronic) for both.

A 
Nephrotic = Proteinuria (frothy urine), hypoalbuminaemia, oedema --> Chronic onset 
Nephritic = Haematuria, hypertension, acute drop in GFR --> Acute onset
25
Q

Define chronic kidney disease.

A

o GFR < 60mL/min/1.73m2 for >3 months

OR

o	Evidence of kidney damage for >3months
	Microalbuminuria
	Proteinuria
	Glomerular haematuria
	Pathological or anatomical abnormalities
26
Q

Briefly explain the pathogenesis of CKD

A
  1. Decrease in nephron numbers, size, or activity (due to primary renal disease)
  2. Hyperfiltration of glomerulus to compensate
  3. Increase glomerular permeability and RAAS activation
    a. Increased glomerular permeability
    - Increased filtration of macromolecules
    - Proteinuria and dyslipidaemia
    b. Increased RAAS activation
    - Renin released stimulated by low GFR (low NaCl delivery to Macula Densa cells)
    - RAAS causes hypertension
  4. Nephrotoxic inflammation results from excess filtration of proteins and RAAS (vasoconstriction of vessels)
  5. Tubulointerstitial Fibrosis
    a. Decrease GFR
    b. Decreased Urine output
    c. Systemic Complications
27
Q

What are four modifiable risk factors for CKD?

A

Diabetes (main cause) – Hyperglycaemia causes kidney damage and fibrosis via AGEs

Smoking – vasoconstrictive effects and carcinogenic potential on blood vessels

Obesity – Hyperfiltration occurs to meet heightened metabolic demand of increased body weight → Renal parenchymal damage (nephron hypertrophy and increase permeability) → RAAS activation → increased hypertension and further damage → Cycle of hyperfiltration and renal parenchymal damage

Hypertension – Damage to blood vessels → Insufficient renal flow → Hypoxia and hyperfiltration → Cycle with further renal parenchymal damage

28
Q

Briefly explain the mechanism of renal osteodystrophy.

A
  1. Reduced Renal Function (i.e. damage and fibrosis)
  2. Reduced activation of Vit. D to Calcitriol (1,25-(OH)2D )
  3. Reduced absorption of Ca2+ from GIT and reduced Ca2+ reabsorption from kidney tubules
  4. Decrease plasma Ca2+
  5. Increased release of Parathyroid Hormone (PTH)
  6. Increase osteoclastic activity (i.e. bone breakdown)
  7. Ca2+ and PO4 released to blood from bone
  8. Reduced Renal function cannot dump excess PO4
  9. Ca2+ raises to normal; PO4 elevated above normal
29
Q 
Which of the following would be the LEAST LIKELY orofacial manifestation of CKD?
A) Pallor
B) Swelling of salivary glands
C) Increased risk of fracture
D) Candidiasis 
E) Gingivitis
A

E)

30
Q

While treating a patient with CKD, which of the following is the correct management?
A) NSAIDS is the first choice of analgesic
B) Dental treatment should be performed the morning of dialysis
C) AB prophylaxis should be provided for patients on dialysis prior to invasive dental treatment
D) Elective dental treatment should be avoided for 3 months after transplant

A

C)

A) Increased bleeding risk aggravated by NSAIDs (also apsirin)
B) Should be performed a day after
D) Should be >6months after transplant

31
Q

Which of the following is incorrect?
A) Gonorrhoea has a gram-negative coccus with high antimicrobial resistance
B) Syphillis is a gram-positive rod that is difficult to culture
C) HSV is a dsDNA obligate human virus with glycoprotein envelope
D) Chlamydia is a gram-negative rod that grows intracellularly

A

B) It is a gram-negative spiral, yes difficult to culture

32
Q

Anderson May Equation: 𝑅𝑜 = 𝛽𝐷𝑐

Explain the various components.

A 
•	Ro = Basic reproductive number
•	β = Probability of infection per sexual act
   - Varies between organisms 
   - 20-50% for gonorrhoea 
   - HIV <1% 
   - HPV>60%
   - Reduced through use of condoms, vaccination, male circumcision 
•	D = Duration of infectiousness
    - Varies between organisms
    - Weeks = Gonorrhoea 
    - Months = HPV and syphilis 
    - Years = HIV, HSV and chlamydia 
    - Reduced through good contact tracing, STI screening and appropriate treatment 
•	c = Rate of new partners
33
Q

Which of the following is incorrect regarding diagnostic tests for STIs?
A) Microscopy is used for diagnosis of gonorrhoea
B) Culture is used as diagnostic for HSV
C) Rapid Ag testing often used for diagnosis of chlamydia
D) Serology can be used for screening syphillis

A

C) Rapid Ag testing mianly used for syphillis only.

34
Q

Which of the following is correct?
A) Gonorrhoea is the most common STI in first world countries.
B) Chlamydia mainly presents with genital lesions
C) Primary syphillis mainly presents with genital rather than oral lesions
D) Chlamydia is the most common STI in the developing world.

A

C)

A) Chlamydia is most common
B) Urethreal and vaginal discharge is most common
D) Trichomoniasis is most common in developing world

35
Q

Wich of the following is most corret regarding the diuretics?

A. Thiazides act on the thick ascending limb
B. Loop diuretics compete with uric acid for secretion transport into the tubule
C. Acetazolamide is a thiazide diuretic
D. Bartter’s syndrome can appear similar to that of someone chronically taking thiazide diuretics

A

B

A. Thiazides act on the NaCl transporter in the distal convoluted tubule
C. Acetazolamide is a carbonic anhydrase inhibitor
D. Bartter’s syndrome can appear similar to that of someone chronically taking loop diuretics

36
Q

Uraemic Syndrome causes all of the following except?

A. nausea
B. pruritis
C. altered mental state
D. endocarditis

A

D

Taken from the block exam

37
Q

What would increase GFR?

A. afferent arteriolar constriction
B. efferent arteriolar dilation
C. decreased plasma colloid osmotic pressure
D. increased tubular hydrostatic pressure

A

C.

Taken from block quiz

GFR is the sum of capillary hydrostatic pressure, intratubular pressure and colloid osmotic pressure

Where capillary hydrostatic pressure is increased = GFR increased

Where intratubular pressure and colloid osmotic pressure are increased = GFR is decreased
- therefore losing one of these or having one lowered would then increase GFR

38
Q

A 68yr old female patient has type II diabetes (15yrs), BP 166/102 and microalbuminuria. She is overweight and har poorly controlled BGL and hypertentsion

Which of the following is she most likely to have

A. minimal change disease
B. IgA nephopathy
C. Acute post-infectiour GN
D. Diabetic nephropathy

A

D

39
Q

What is the BP target of a CKD patient?

A

BP should consistently be below 140/90

IF + albuminuria BP should be below 130/80

40
Q

What are some of your main concerns as a dentist with a CKD patient?

A

Bleeding
Renal clearance of medications
Transplant patients will be on immunosuppresants
- be aware of oral manifestations of these
- also be aware that these can increase the aptients risk of developing malignancies

41
Q

Which of the following is correct regarding CKD staging?

A. stage 1 - chronic kidney damage; normal or decreased GFR =90
B. Stage 2 - mild decrease in GFR 60-89
C. Stage 4 - kidney failure, ESRD
D. Stage 3 - the 5yr mortality rate is around 50%

A

B is correct

Stage 1 - chronic kidney damage; normal or increased GFR >/=90
Stage 2 - mild decrease in GFR 60-89
Stage 3 (3, 3a & 3b) - moderate decrease in GFR 30-59, 5yr mortality rate 24%
Stage 4 - severe decrease in GFR 15-29, 5yr mortality rate 46%
Stage 5 - kidney failure, ESRD <15 - on dialysis, 5yr mortality rate >50%

42
Q

LA is safe in a CKD patient unless there is some secondary severe bleeding tendency

True/False

A

True

43
Q

Which of the following is not appropriate for dental care of the CKD patient?

A. they should be screened for bleeding disorders and you should obtain a platelet count
B. BP should be monitored before and during the procedure
C. those who are taking large doses of corticosteroids should have a loading (extra) dose before surgical procedures to avoid adrenal crisis
D. GFR <50mL/min should delay elective dental care

A

C - those who are taking large doses of corticosteroids should not take a loading (extra) dose
They simply need to take their usual dose before surgical procedures to avoid adrenal crissis

44
Q

What are the litre distributions of total body water?

A

40L average

25L intracellular
12L interstitial
3L intravascular

45
Q

What organs are included in the upper urinary tract?

A

Kidneys and Ureters

46
Q

What is the average size of the kidney

A

10x5x2.5

47
Q

Which of the following is not a clinical feature of CKD

A. anaemia
B. metabolic alkalosis
C. protein wasting
D. electrolyte disturbance

A

B. metabolic acidosis is a feature but not alkalosis

48
Q

Treponema Pallidum is the pathogen associated with Chlamydia

True/False

A

False - it’s the pathogen causing Syphillis

49
Q

Match the condition/cause with the outcome

  1. Hyponatramia w/ increased ECF volume
  2. Hyponatramia w/ decreased ECF volume
  3. Hyponatramia w/ normal ECF volume

Diarrhoea, congestive heart failure, SIADH (syndrome of inapropriate ADH secretion)

A
  1. Hyponatramia w/ increased ECF volume = congestive heart failure
  2. Hyponatramia w/ decreased ECF volume = diarrhoea
  3. Hyponatramia w/ normal ECF volume = SIADH
50
Q

Which of the following is correct regarding replacement fluids?

A. 0.9% sodium chloride (saline) distributes through the extracellular space
B. 5% glucose distributes through the extracellular space similar to saline
C. Colloid solutions distribute evenly through whole body water
D. Blood expands the blood compartment and has less diffusion into interstitial than saline

A

A

Glucose - is isotonic and distributes through whole body water

Colloid - expands the blood compartment and has some diffusion into interstitial space (but less than saline).

Blood - restricted to the intravascular compartment

DMD2 (13 decks)

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