Renal Failure Flashcards Preview

Year 3 Human Disease > Renal Failure > Flashcards

Flashcards in Renal Failure Deck (45):
1

ways to measure excretory renal function 4

gfr= glomerular filtration rate

-plasma/ serum creatinine
-estimated GFR: MDRD formula (sex, age, race, creatinine)
-creatinine clearance
-isotope GFR (usually Cr15 EDTA)

2

problems with serum/plasma creatinine 4

-related to muscle mass (more muscle, more creatinine so normal has big range)
-may not be elevated above 'normal' until 50% GFR lost
-changes within normal range are significant
-artefacts: muscle damage, drugs

3

what kind of creatine measurements are most useful

serial

4

write modified MDRD formula

eGFR (ml/min/1.73m2)= 2.107x serum creatinine (umol/l)-1.154 x age -0.203

5

normal GFR range

100-200

6

define acute kidney injury AKI and outcome

rapid loss of renal excretory function (over hours or days rather than weeks)
reversible if underlying condition is treated

7

define chronic kidney disease CKD

slowly progressive loss of excretory renal function. original cause often unknown, usually irreversible (management aimed at slowing progression)

8

3 causes of AKI

-pre-renal: problem in blood supply to kidney (thrombosis, dec bp)
-intrarenal: direct damage to kidneys due to inflammation/ toxins/ drugs/ infection/ reduced blood supply
-post-renal: obstruction to urine flow eg prostate enlargement, kidney stones, bladder, tumour, injury

9

4 causes of pre renal AKI

-salt and water depletion (diarrhoea, vomiting, diuretics, fever, poor fluid intake)
-haemorrhage (esp gastrointestinal)
-hypotension (heart failure, drugs, sepsis, shock)
-renovascular disease

10

types of renal AKI and % 3

85% tubular necrosis (mostly due to pre renal factors eg low bp)
10% interstitial nephritis
5% glomerulonephritis

11

how to diagnose kidney disease

-urine dipstick
-renal biopsy (interstitial nephritis, acute glomerulonephritis

12

8 causes of toxic AKI

-antibiotics eg aminoglycosides, amphotericin
-radiographic contrast media (inc non-ionic)
-chemotherapy agents esp cis-platinum
-rhabdomyolysis
-intravascular haemolysis
-tumour lysis
-solvents (inc ethylene glycol, carbon tetrachloride)
-hepatorenal syndrome

13

3 common causes of post renal AKI

-obstruction to outflow from both kidneys or to outflow from a single functional kidney esp prostate in males, cervix in females
-retroperitoneal fibrosis, neurogenic bladder
-intra-renal obstruction eg crystals or casts (esp myeloma)

14

what does prognosis of post renal AKI depend on 2

-underlying condition
-duration of obstruction

15

causes of chronic kidney disorder 5

-diabetic neuropathy MOST COMMON
-genetic causes (esp polycystic kidney disease) 10%
-vascular disease
-chronic glomerulonephritis
-chronic urinary outflow obstruction

16

classification system of chronic kidney disease

5 stage according to eGFR
1: normal kidney function with some other evidence of kidney disease
5: eGFR less than 10-15 ml/min ie need for renal replacement

17

consequences of renal failure 7

-accumulation of 6: K+, urea, creatinine, H+, water, PO4
-deficiency of 2: erythropoitin--> anaemia
1 alpha vitamin D3 --> hypocalcaemia, hyper parathyroid hormone, bone disease
-delayed drug excretion
-pulmonary oedema
-xerostomia
-uraemic stomatitis (white/ grey on FOM)
-brown tumour

18

outcome of K+ accumulation

changes polarisation of cells --> large T waves --> cardiac arrythmias --> sudden death

19

how to control potassium

diet (eg less bananas)

20

explain renal bone disease

less calcium --> less vit D activation --> non calcified osteoid --> bone resorption

21

4 tx for renal replacement therapy

-dialysis/ transplantation
-erythropoietin
-1 alpha vitamin D
-sodium bicarbonate

22

normal blood Hb levels

130-150g/l

23

how does a haemodyaliser work

contains small plastic 'capillaries' surrounded by dialysis fluid for filtration

24

explain arterial-venous fistula

sew artery to vein --> blood flows in to vein --> dilates vein --> can put needles in to vein for dialysis

25

why are anticoagulants used in dialysis and examples 3

stops blood clotting during dialysis
-heparin for dialysis
-warfarin for access patency
-aspirin

26

what does CAPD stand for and how does it work

Continuous Ambulatory Peritoneal Dialysis
needle and dialysis in to peritoneum (space between organs) --> fluid exchanged over peritoneal membrane continuously/ 4 times per day

27

6 general consequences of immunosuppression

-infection (correlation with corticosteroid dosage)
-viral transmission with transplant esp CMV
-malignancy (esp viral eg lymphoma, skin, cervix. UV exposure and skin type important)
-hypertension
-dyslipidaemia
-osteopaenia

28

2 main causes of gingival hyperplasia

-cyclosporin (immunosuppression)
-calcium blockers (dipines)

29

5 adverse effects of cyclosporin

-nephrotoxicity
-tremor
-hirtuism
-gingival hypertrophy (worsened by nifedipine)
-interactions (esp macrolides, diltiazem)

30

4 important drug interactions

-cyclosporin and macrolides (erythromycin, clarithromycin)
-cyclosporin and diltiazem
-cyclosporin and enzyme inhibitors
-azatioprine and allopurinol

31

5 considerations for dental care after renal transplantation

-good OH essential
-gingival hypertrophy (cyclosporin, nifedipine)
-inc susceptibility to infection
-antibiotic prophylaxis
-drug interactions esp erythromycin etc

32

6 normal functions of kidneys

-excretion of salt/ water/ waste products of metabolism (via urine)
-regulation of acid-base (H+) in tubules
-regulation of blood pressure (with renin)
-production of erythropoetin (stimulates RBCs)
-activation of vit D (1 alpha hydroxylase)
-excrete water soluble drugs/ metabolites

33

order blood moves around kidney

afferent arteriole --> glomerulus -> vasa recta

34

order of nephron system kidneys

bowmans capsule --> proximal convoluted tubule -->loop of henle --> distal convoluted tubule --> collecting duct

35

increase in serum creatinine in AKI stage
1
2
3

1: 1.5-2
2: 2-3
3: >3 or >354umol/L with acute increase of >44umol/L

36

most common known cause of kidney failure in pts starting renal replacement therapy in UK

diabetes

37

% of people in england with diabetes

7.4%

38

proportion of people with diabetes who have kidney disease

18%-30%

39

% of patients having tx/ dialysis whose kidney disease was due to diabetes

14%

40

categories of GFR

G1: normal/ high GFR
G2:mildly decreased
G3a: mild-mod decreased
G3b: mod-severely decreased
G4: severely decreased
G5: kidney failure

41

what is
a. normal GFR
b/ GFR in kidney failure

a. normal GFR: >90ml/min/1.73m2
b. GFR in kidney failure:

42

presentation/ symptoms of chronic kidney disease

often asymptomatic until CKD4/5 (GFR

43

3 lab changes of CKD

anaemia
disordered bone mineral metabolism
acidosis

44

AKI/ CKD consequeneces:
a. accumulation of (6)
b. deficiency of (2) and consequences
c. delayed (1)

a. accumulation of (6): K+, urea, creatinine, H+, water, PO43-
b. deficiency of (2) and consequences: erythropoietin --> anaemia. 1alpha vit D3 --> hypocalcaemia, hyperPTH, bone disease
c. delayed (1): drug excretion

45

what does uraemic stomatitis look like

white-grey pseudomembranous lesion on tongue and FOM