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Renal and Genito-Urinary System > Kidney and Renal Disease > Flashcards

Flashcards in Kidney and Renal Disease Deck (21)
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1

What are the main functions of the kidneys

- Filter 180L fluid daily
- Clear waste
- Balance acid/waste

Production of hormones: Control blood pressure (renin)

Help to make blood (erythropoietin)

Regulate bone health (Ca, P) (Vit. D).

2

What is creatinine?

- End product of skeletal muscle catabolism

- Dietary meat intake can increase creatinine

- Released into the circulation at a constant rate

- Creatinine is freely filtered into the glomerulus

- 15% of urinary creatinine is secreted by the tubules

- Used to calculate Glomerular Filtration Rate

3

How to calculate the GFR

- Cannot measure directly. Need to measure creatinine and creatinine clearance (ml/min)

- GFR declines with ageing

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

4

What are the different types of Kidney Dysfunction

1.) SALT & WATER HOMEOSTASIS
- Changes in total body water
- Changes in blood pressure
- Changes in urine volume or concentration

2.) EXCRETION OF WASTE PRODUCTS
- Uraemia
- Acidosis e.g. lactic acid, ketoacids
- Others: Potassium, Phosphate, Uric acid
- Clearance of drugs

5

Kidney Function Dysfunction continued...

3.) HUMORAL DISTURBANCE:
- Anaemia
- Renal bone disease
- Hypertension

4.) BARRIER FAILURE
- Haematuria
- Proteinuria
- Lipiduria

6

How do we treat chronic kidney disease

1.) MILD/MODERATE:
- Diet/Fluid balance
- Supplements - Alkali, Vitamin D, Iron
- Drugs - Phosphate, Hypertension, Anaemia

specific conditions - immunosuppression

2.) SEVERE:
-  Dialysis
- Transplantation

3.) VERY SEVERE:
Kidney replacement treatment:
- Peritoneal Dialysis
- Haemodialysis
- Transplant

7

What is Cystitis?

Infection of the bladder:
- Dysuria, urinary frequency, urgency, suprapubic pain +- haematuria

8

What is Pyelonephritis?

Infection of the kidney
- Cystitis + systemic features (fever, flank pain)

Test - Urinalysis, urine culture (E.coli, proteus/klebsiella)

Men - prostatitis (different if recurrent)
Risk factors: sexual intercourse, immunosuppression, diabetes, urinary tract obstruction

9

What are the renal causes of hypertension?

- Reno vascular disease (asymmetry on u/s, symptoms)
- Fibromuscular disease

- Any cause of acute or chronic kidney disease
(clue: increased creatinine, blood/proteinuria)
- Polycystic kidney disease
- Glomerulonephritis: IgA nephropathy
- Post renal transplant - medication

10

What is Renovascular disease?

A progressive condition that causes narrowing or blockage of the renal arteries or veins (blood vessels that take blood to and from kidneys)

11

What is Fibromuscular dysplasia?

Non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery
- Arterial stenosis, arterial occlusion aneurysm.

12

What is Polycystic Kidney Disease?

- Autosomal dominant inheritance
- 1 in 400-1000 (world)
- Gradual progressive decline in kidney function
- ESRF in -50% by 60yrs
- Marked clinical variability
- Earliest features include hypertension, UTIs
- polycystic livers
- Intracranial aneurysms

13

What is Glomerulonephritis?

Inflammation of glomeruli - filtering units kidney

Clues - active urinary sediment (blood/proteinuria)
- Dysmorphic red cells - red cell cast

Various causes - Age and presentation help differentiate diagnosis:
- Nephritic syndrome
- Nephrotic syndrome

14

What is Nephrotic Syndrome?

A collection of symptoms due to kidney damage

- Heavy proteinuria
- Low albumin
- Peripheral Oedema

And possibly...
- Thrombosis - DVT, PTE
- Hyperlipidaemia

Normal creatinine
- Acute tubular necrosis - older patients
- Acute interstitial nephritis - drug reaction (minimal change)
- Myeloma

CAUSES - IDENTIFY ON RENAL BIOPSY DEFINITIVELY:
- Focal segmental Glomerulosclerosis (FSGS)
- Membranous
- Diabetes
- Minimal change
- Amyloid

15

What is Nephritic Syndrome?

Combination of:
- URINALYSIS:
- OLIGURIC AKI
- HYPERTENSION
- OEDEMA +-

Standard investigations:
- Blood test
- Renal biopsy

Most commonly caused by Acute Glomerulonephritis

Crescentic Glomerulonephritis:

- Assoc. systemic symptoms: fevers, weight loss
- Upper/resp tract symptoms, rash

16

Overview of Bladder Tumours

- Bladder tumours classified by WHO by

- Invasiveness - determines tumour, nodes, mets score
- Determines treatment & prognosis
- Most commonly: urothelial or squamous cell

Present: painless haematuria >40yrs

Risk factors: carcinogens (tobacco, occupational - dyes, male gender or increase in age)

17

Overview of Renal Tumours

- Can be primary or secondary (detected clinically)
- 80/85% renal cancers are renal cell carcinomas (RCC)
- 8% transitional cell cancers arise in renal pelvis
- Increasing incidence of small, asymptomatic RCC detected on incidental abdominal imaging
- Present: mass effect, pain, haematuria, weight loss.

Risk factors: smoking, obesity, hypertension

Investigations:
If signs/symptoms - CT imaging, staging (TNM)
If small - aim for resection and histology

Complications of Renal Tumours:
- Metastases
- Recurrence
- Nephron sparing surgery (partial resections)

18

Things to consider when treating patients with chronic kidney disease

THEY MAY BE:
- Immunusuppressed
- Malnourished (prone to infections)
- Anaemic
- Has bleeding tendency (platelet dysfunction)
- Cardiovascular disease is common
- Hypertensive
- Fluid overload
- Vascular sclerosis

19

Complications of ESRF Transplantation

IMMUNOSUPPRESSION:
- Infection
- Cancer (skin, post Tx lymphoproliferative (EBV))
- Hypertension, Diabetes

CARDIOVASCULAR DISEASE

RECURRENT DISEASE

GINGIVAL OVERGROWTH associated with:
- Cyclosporin (transplants/immunosuppression GN)
- Antihypertensives - calcium channel blockers (Amlodipine, Diltiazem, Nifedipine

20

Significance of kidney failure and the dentist

Especially patients stage 4-5 are:
- Anaemic
- Have a bleeding tendency
(Minimise blood loss, transfusions, maximum homeostasis)

- Has CVD:
Hypertensive, fluid overload, valvular sclerosis.
(Prophylactic antibiotics, May have difficulty lying supine, Likely to have fluid restriction.

- Hyperkalemic (potassium level higher than normal) or pre-dialysis
(Be careful with GA and monitor serum K post-operatively (rebounds)).

21

Significance of chronic kidney disease and drugs

Generally be careful with appropriate dosing of medications commenced
- Ensure considered correct dose and frequency for eGFR

Be aware of medication interactions
- e.g. Clarithromycin/Erythromycin/Fluconazole and tacrolimus

If in doubt, aim to plan electively or contact the renal unit to query