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Endocrinology > The kidney in health and disease - for clinical dental trainees > Flashcards

The kidney in health and disease - for clinical dental trainees Flashcards

1
Q

Normal kidney functions

A
  1. Salt and water homeostasis
  2. Excretion of waste
  3. Humoral regulation of other organs
    - bone (Vti D)
    - RBCs (erythropoietin)
    - BVs (renin)
    - selectivity barrier
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2
Q

Nephron

A 
Functioning unit of kidney
Tubules
-proximal (convoluted and straight)
-distal
-collecting ducts
-loop of Henle
We have between 500,000 and 2,000,000
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3
Q

Glomerulus

A

Folded, large surface area
Filters blood that’s passing through
-retains protein and blood cells
-25% of cardiac output goes through here

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4
Q

Creatinine and GFR calculation

A 
GFR calculated (24hr urine/plasma):
Creatinine clearance: \_\_\_\_\_\_ml/min
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5
Q

Formulae to estimate GFR (eGFR)

A

Modification of Diet in Renal Disease (MDRD)
(4) - Plasma creatinine, age, gender, race
Recently switched to CKD-EPI equation
- Performs better at higher eGFR

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6
Q

Formulae to estimate GFR (eGFR)

A

Modification of Diet in Renal Disease (MDRD)
(4) - Plasma creatinine, age, gender, race
Recently switched to CKD-EPI equation
- Performs better at higher eGFR

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7
Q

Dialysis

A

2l bags each

120l of fluid processed by kidney each day

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8
Q

Where is vit D made?

A

Skin

-processed by kidney and liver

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9
Q

Creatinine and GFR relationship

A

GFR varies inversely with reciprocal of plasma creatinine (1/Pcr)

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10
Q

Kidney dysfunction

A
  1. Salt and water homeostasis
  2. Excretion of waste products
  3. Humoral disturbance
  4. Barrier failure
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11
Q

Kidney dysfunction - salt and water homeostasis

A
  • changes in total body water
  • changes in BP
  • changes in urine volume or concentration
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12
Q

Kidney dysfunction - excretion and waste products

A
  • uraemia
  • acidosis e.g. lactic acid, ketoacids
  • others: potassium, phosphate, uric acid
  • clearance of drugs
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13
Q

Kidney dysfunction - humoral disturbance

A
  • anaemia
  • renal bone disease
  • hypertension
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14
Q

Kidney dysfunction - barrier failure

A 
Haematuria
-red/ blood
Proteinuria
-frothy urine
-precipitates as it cools down
Lipiduria
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15
Q

K/DOQI classification

A 
Stages 1-5
GFR decreases as stage increases
1. Kidney damage/ normal GFR >90
2. Mild renal insufficiency GFR 89-60
3. Moderate renal insufficiency GFR 59-30
4. Severe renal insufficiency GFR 29-15
5. Kidney failure GFR <15
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16
Q

Treatment of chronic kidney disease - mild/ moderate

A 
Diet/ fluid balance
Supplements
-alkali
-vitamin D
-iron
Drugs
-phosphate
-hypertension
-anaemima
-specific conditions: immunosuppression
17
Q

Treatment of chronic kidney disease - severe

A

Dialysis

Transplantation

18
Q

Treatment of chronic kidney disease - very severe

A

Kidney replacement treatment

  • peritoneal
  • dialysis
19
Q

Signs of renal disease

A 
Flame shaped haemorrhages  in retina
Oedema
Haemorrhage in heart
Rough 'moth-eaten' edges of bone 
RBCs broken up - schistocytes
20
Q

Primary cause of ESRF in prevalent patients UK, top 5 causes <65 years

A
  1. Glomerulonephritis
  2. Diabetes
  3. Pyelonephritis
  4. Polycystic Kidney Disease
  5. Hypertension
21
Q

Fistula

A

Abnormal connection between artery and vein

Manmade for pts with kidney disease

22
Q

Why do we avoid using catheters

A

Inconvenience for patients
Bleeding
Infection
Air embolus

23
Q

Primary cause of ESRF in prevalent patients UK, top 5 causes >65 years

A
  1. Diabetes
  2. Glomerulonephritis
  3. Polycystic Kidney Disease
  4. Pyelonephritis
  5. Hypertension
24
Q

Dialysis

A 
3 times a week on average
-ideally every day
Peritoneal dialysis
-not as efficient
-cheaper
-probably 4x day
25
Q

Clinical syndromes

A 
Acute renal failure
Chronic renal failure
Nephrotic syndrome (proteinuria)
Nephritic syndrome (haematuria)
Malignant (accelerated phase) hypertension
26
Q

Primary diagnosis in prevalent RRT patients in E&W

A
  1. Glomerulonephritis
  2. Pyelonephritis
  3. Diabetes
  4. Polycystic kidney disease
  5. Hypertension/ renovascular
27
Q

Splinter haemorrhage cause

A

Endocarditis
Vasculitis (disease of small BVs)
-renal??

28
Q

Splinter haemorrhage history

A

Is it on one or both hands?
Are you right or left handed?
-can be due to gardening or strenuous activity

29
Q

Blotchy rash on cheeks, woman

A

Systemic Lupus Erythematosus

-kidney failure

30
Q

Red swollen hand
Cotton wool spots (retina)
Hands - flexion deformity, swollen, red and shiny

A

Completely blocked kidney due to excess material

Systemic sclerosis

31
Q

ESRD complications

A 
Cardiovascular disease
-hypertension
-K-related arrhythmias
-cardiac valvular calcifications
Infections
Malnutrition
Renal osteodystrophy
Immunosuppression
-infection (atypicals)
-cancer (skin, post tx lymphoproliferative)
-hypertension, diabetes
CVD
Recurrent disease
32
Q

Oropharyngeal candidiasis

A

Common problem for immunosuppressed pts

33
Q

Gingival overgrowth associated with which drugs

A

Cyclosporin
-transplants/ immunosuppression
Antihypertensives
-calcium channel blockers (Amlodipine, Diltiazem, Nifedipine)

34
Q

Kidney failure and the dentist

A 
The kidney patient, especially patients with stage 4-5 (eGFR<30, Advanced CKD) are:
-anaemic
-have a bleeding tendency
-->Minimise blood loss
-->Transfusions (complicates future transplant)
-->Maximum homeostasis
Has CVD: 
-hypertensive
-fluid overloaded
-valvular sclerosis
-->prophylactic antibiotics
-->may have difficulty lying supine
-->likely to have fluid restriction
-hyperkalemic or pre-dialysis
-->Be careful with GA
-->Monitor serum K post-operatively (rebounds)
35
Q

Chronic kidney disease and drugs

A

Generally be careful with appropriate dosing of medications commenced
Ensure considered correct dose and frequency for eGFR
Be aware of medication interactions
eg Clarithromycin/erythromycin/fluconazole and Tacrolimus
If in doubt, aim to plan electively or contact the renal unit to query

36
Q

Creatinine

A

End product of skeletal muscle catabolism
> by dietary meat intake
Released into circulation at constant rate
Freely filtered at glomerulus
-15% of urinary creatinine secreted by tubules
-used to calculate GFR

Endocrinology (5 decks)

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