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2nd year > Kidney medicine > Flashcards

Kidney medicine Flashcards

1
Q

What are the two parts of the kidney?

A
  • medulla- where urine is concentrated
  • Cortex- contains the nephrons.
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2
Q

How does the Renal corpsule filter?

A

The afferent arteriole is wider than the efferent arteriole.

Blood enters the glomerulus faster than it can leave.

This increases blood pressure & forces the water out via the filtration barrier.

The glomerulus is porous to allow water movement but the pores are too small to facilitate protein movement.

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3
Q

What is polyuria?

A

Peeing too much

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4
Q

What is dysuria?

A

Pain when peeing

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5
Q

What is haematuria?

A

Blood in pee

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6
Q

What is proteinuria?

A

Protein present in pee

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7
Q

What is uraemia?

A

Waste products present in the blood.

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8
Q

How do we measure Renal function?

A

Creatinine levels in serum or urine (after 24hrs). These are normally low in the body (80µmol/L ) and rise when there is disease.

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9
Q

What do we lose when the kidney is not working?

A
  • Ability to excrete
  • Ability to maintain water and electrolyte balance.
  • Ability to maintain the acid/base balance. (in disease hydrogen ions are not being excreted)
  • The renal endocrine function:

Erythropoeitin

Renin for renin angiotensin system.

calcium metabolism.

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10
Q

Explain what the pre-renal cause of kidney failure is?

A

This is blood flow related. e.g.

Hyperfusion of the kidney (blood flow is stopped rapidly meaning there is not enough oxygen for the kidney cells.

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11
Q

Explain what the renal causes of kidney failure are?

A

Kidney damage.

This can be due to:

Disease

Drug

Trauma - causing rhabmyolysis

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12
Q

Explain what the post renal causes of kidney failure are?

A

Kidney obstruction e.g.

Kidney stones

Prostate blockage of the urinary tract in male.

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13
Q

What is acute renal failure and how does the creatinine level compare to a healthy individual?

A

This is when the kidney suddenly stops working.

The patient’s creatinine level is > 200 µmol/L

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14
Q

What happens in a patient with acute renal failure?

A

First anuric- the patient does not produce urine so there is a fluid build up in the body (pulmonary oedema, ankle oedema)

Weight gain due to the fluid retention.

Then this develops into polyuria. The ability of the patient to filtrate is there but they are unable to concentrate the urine.

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15
Q

What are the problems associated with acute kidney disease?

A
  • Hyperkalaemia- Too much or too little K+. This can make the nerves too excitable. Which affects cardiac rythmn- making heart attacks likely.
  • Uraemia - high urea level
  • Acidosis- low bicarbonate level.
  • Increased respiratory rate-patient is not getting rid of H+ so body has to compensate for acidic levels by increased breathing out of CO2
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16
Q

Compare primary and secondary chronic renal function?

A

Primary- a problem with the kidney itself

e.g. polycystic kidney disease.

Secondary- a disease which causes the kidney problem

e.g. hypertension, diabetes.

Drugs

17
Q

What is nephrotic syndrome?

A

Nephrotic syndrome- a complication of chronic kidney failure.

Loss of proteins (mainly albumen) reduces plasma oncotic pressure. Water moves out of vessels, causing oedema.

There is also loss of proteins for co-agulation causing inappropriate clotting.

18
Q

Why are NSAID’s bad for the kidney?

A

They inhibit prostaglandins which are involved in the control of glomerular function.

The NSAIDs cause Interstitial nephritis.

19
Q

How do you reduce the rate of kidney decline?

A
  • control hypertension
  • control diabetes
  • eliminate nephrotoxic drugs.
  • Control vascularitic disease
20
Q

How do you correct the patient’s fluid balance?

A
  • restrict fluid intake
  • restrict salt/ pottasium/protein.
21
Q

How do you manage chronic renal failure?

A
  • slow down decline
  • correct patient’s fluid
  • Treat deficiencies (ethrypoeitin/ Calcium)
  • Remove outflow obstruction
  • Treat infection.
22
Q

What is end stage renal disease?

A

When there is no kidney function left.

Creatinine level > 800

23
Q

What is the dental relevance of renal failure?

A
  • Risk of anaemia
    ——Causing oral ulcers/ Dysesthesia- painful tongue & mucosa.
    • Uraemic stomatitis
    ——White patches on the mucosa due to increased blood urea levels.
    • Dry mouth and taste disturbance (Fluid restriction and electrolyte imbalance)
    • At greater risk to oral opportunistic infections.
    • Signs of inflammation can be masked.
    • Be careful with Drugs and doses dependant on renal function.
    —check all drugs with the renal physician.
    —Avoid NSAIDS and some tetracycline
    —Reduce dosage of other drugs
    • Bleeding tendencies and Defective haemostasis (platelet dysfunction)
    • Infections can be poorly controlled.
    • There is an increased risk of blood borne viral infections
    • Consult the renal physician
24
Q

Compare the two types of dialysis treatment?

A

Haemolydialysis - Blood is filted through a dialysis machine, cleaned and then returned to the body.

Peritoneal dialysis- Fluid pumped into the peritoneum (this absorbs waste from the blood stream)

25
Q

Kidney transpant is a cure. Discuss

A

Incorrect.

The transplanted kindey will only work for so long, then the patient will need to have another transplant.

26
Q

Discuss the supplements that a patient with End stage renal failure will need?

A

Erythropoeitin- For red blood cells

Vitamin D- to maintain bone mass.

27
Q

Discuss the problems with having a transplant?

A
  • The body may reject it
  • IMMUNOSUPPRESSION (at risk of infection)
    *
28
Q

What do you need to consider when treating a patient that is on dialysis?

A
  • Treat them after they have had dialysis
  • Check with their renal doctor regarding medications (can the dialysis machine remove the medication? Do not want accumulation)
  • Do not use dialysis shunt for anything as if it gets infected then bad for patient dialysis.
29
Q

What do you need to consider when treating a patient that has just had a Kidney transplant?

A

They will be on immunosuppressants (greater infection risk) e.g. cyclosporin

Could also be on steroids (prednisolone) -steroidal side effects.

30
Q

What is the main bacteira responsible for a UTI?

A

E.coli

31
Q

What is cystitis?

A

Inflammation of the bladder.

32
Q

What is the protective function of urine?

A

To wash out the bacteria trying to ascend into the urinary tract.

33
Q

How do we treat UTI?

A

Drink more fluids - to get body to wash out bacteira

Pee more

Antibiotics (only if infection has gone too far)

34
Q

What are Renal Caniuli and how do we treat them?

A

Kidney stones- Treated by lithotrypsy (break up the kidney stones and extract them)

35
Q

What is the prostate?

A

This is a gland found below the bladder in males. It secretes prostate fluid

36
Q

What is prostatitis?

A

Inflammation of the prostate gland due to infection.

This causes permanent narrowing of the renal passage.

37
Q

What is benign prostatic hypertrophy and how do you treat it?

A

This is growth of the prostate.

it is treated by drugs to make the gland shrink ( e.g. alpha blocking drugs)

And then surgery.

38
Q

Discuss the hormone treatment for prostatic cancer?

A

Prostatic cancer tumours are hormone sensitive. Their growth is influenced by adrogens e.g. testosterone.

So anti-androgen drugs would reduce the growth.

2nd year (63 decks)

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