renal system (not comprehensive) Flashcards
what is the main function of the kidneys
- water and electrolyte homeostasis
- acid base balance
- erythropeitin
- renin
- activate vitamin D
- excretory function
if you find ___ in pee, your kidneys are not working. Why?
rbc, blood, proteins, immune cells
^^
it means your kidneys are not working. those by right should not be able to filter across glomerulus, and or should not be rebsorbed
healthy gfr and unhealthy gfr rate
healthy above 90
unhealthy below 60
Difference between acute and chronic renal failure
- Acute rapid over hours or days, reversible with time
- Chronic gradual loss of function over years , irreversible
what causes pre, renal, post failure
pre renal - problems with circulation of blood into the kidneys
renal - problems with kidney itself
post renal - problems with outflow
what causes acute pre renal renal failure
hypovolaemia, diarrhoea, dehydration
something that causes a sudden large drop in BP, large decrease in GFR
what causes intrarenal renal failure
- damage to kidneys itself
- chronic disease
- inflammation/ infections eg glomerular nephritis
- drug damage
- trauma
what are some examples of outflow obstruction
UTI
UT obstruction
- tumours
- stones (renal calculi)
- BPH benign prostate hypertrophy
UTmalignancy
how to diagnose renal failure
eGFR
should there be creatinine in blood?
no, creatinine should not be getting reabsorbed
serum creatinine >200umol/L means what
acute renal failure
what can hyperkalaemia cause?
cardiac arrest
why is there ankle and pulmonary odema in ACUTE renal failure?
there is NO urination at first, leads to volume overload, fluid pools in lungs and ankles
what happens after zero urination in acute renal failure
polyuria ie pee alot
this is because filtration function has returned but concentration ability has not returned
main cause of chronic kidney failure
hypertension
diabetes
other than hypertension and diabetes, what other causes of kidney failure is there
nephrotoxic drugs
NSAIDs
glomerulonephritis
vasculitis
aorta or renal artery disease
polycystic kidney disease
Diagnosis of chronic kidney disease
eGFR – less than 90ml/min = normal or minimal damage
less than 60ml/min = irreversible damage and decreased function
less than 15ml/min = end stage renal disease
creatinine 800-1000umol/L = end stage renal disease
Treatment of chronic renal failure
- manging diabetes and hypertension
- manage vasculitic diseases
- dialysis
- restrict fluid intake, salt, potassium, proteins
- eliminate nephrotoxic drugs, NSAIDs
- end stage renal disease -> renal transplant
- correct anaemia deficiency by blood transfusion
- correct calcium deficiency
- remove renal stones
- treat any chronic kidney inflammation
what to take note when prescribing medication
- avoid NSAIDs
- reduce dosage
- ## check all drugs with renal physician
oral manifestations of renal failure
growth may be slower
- oral ulceration
- painful mucosa and tongue
- white patches aka uremic stomatitis
- oral opportunistic infections
- dry mouth
- taste disturbances
- bleeding tendencies
- renal osteodystrophy -> loss of lamina dura
- bony radiolucency
what can chronic renal failure lead to
- less vit D activated -> hypocalcaemia -> increased bone resorption -> osteodystrophy
- falling GFR -> increased renin -> hypertension
- less erythropoietin -> less rbc -> anaemia
- weakness
- nausea
- polyuria
- renal bone diseases
o osteodystrophy
o osteomalacia
RENAL REPLACEMENT THERAPY
- transplant
- dialysis
dialysis solution contains
o low conc of solutes that you want out of the blood
o high conc of solutes that you want in blood
what sort of diffusion in dialysis
- passive diffusion
haemodialysis vs peritoneal dialysis
a. blood filtered outside the body in a dialysis machine
b. artificial membrane used
c. done at a centre over hours
a. dialysis solution pumped into the peritoneal cavity, with the peritoneal membrane used as a filtering membrane
b. done at home all day or night
which dialysis requires heparin
haemodialysis
when should dental treatment be done after dialyss
Dental treatment should be done day after haemodialysis
why Liase with the physician before prescribing drugs
drug you prescribe needs to be able to be removed by dialysis machine
does renal transplant or dialysis have higher survival rate
transplant
- higher survival rate than dialysis
- normal renal function after transplant
- no dietary restriction
potential effects of transplant
- acute or chronic rejection
- requires immunosuppressive drugs for life -> prone to infections
- high CVS mortality unclear why
- osteoporosis risk still present
- risk of candidiasis from steroids
- risk of skin, lip , oral cancer
Urinary tract made up of
kidneys, bladder, ureter, urethra
is urine sterile
Urine is usually sterile
any bacteria or white blood cells detected implies infection
what urine sample should we be looking at
MID stream urine sample
Why is UTI more common in woman?
- urethra shorter in women than men, easier for bacteria spread
Most common bacteria in UTI
- e.coli
- staph, fungi, virus and TB possible
how does bacteria get into urine
- bacteria gets through lining of bladder into urine
Cystitis
bladder inflammation
Urethritis
ureter inflammation
what does a reagent strip test urine for
- leukocytes
- blood
- nitrate
UTI symptoms
- dysuria
- urinary frequency
- cloudy urine
- offensive smelling urine
- subpar pubic pain
What increases risk of UTI
- women
- diabetes
- immune system compromised
- urinary tract abnormalities
- spinal cord injuries causing bladder contractility issues
UTI can lead to?
- cystitis
- renal infection
- prostate infection
- urethritis
UTI treatment
- increase fluid intake
- antibiotics not necessary
- peeing regularly can flush the bacteria out -> return to health naturally
benign prostatic hypertrophy BPH symptoms
i. difficulty in pee
ii. slow stream low pressure
iii. increased frequency since bladder doesn’t empty out
iv. nocturia
v. urgency
treatments for BPH
i. alpha blocking drugs
ii. anticholinergic
iii. diuretics
iv. surgery to remove obstruction around urethra
prostate malignancy or BPH more common cause for obstruction?
BPH
are renal stones / calculi painful
painless in kidney
extremely painful in the ureter
how to treat renal calculi
treat with Lithotrypsy
- ultrasound shock waves to break up the stones
- pass out in urine
