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Flashcards in Renal Failure Deck (34)
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1

What is polyuria

The frequent passage of large volumes of urine

2

What is dysuria

Discomfort or burning with urination

3

What is haematuria

The presence of blood in urine

4

What is proteinuria

Protein in urine

5

What is uraemia

Kidneys cannot remove urea from the body so waste from urine accumulates in the blood

6

How can renal function be measured

Serum urea
Serum creatinine
eGFR - estimated glomerular filtration rate
24 hour urine collection - best measure

7

Describe eGFR

Modern quick way of looking at renal function calculated from U&Es measurement

8

What happens during renal failure

Loss of renal excretory function
Loss of water and electrolyte balance
Loss of acid base balance
Loss of renal endocrine function

9

What is controlled by renal endocrine function

Erythropoietin
Calcium metabolism
Renin secretion

10

Describe the different types of renal failure

Acute renal failure - rapid loss of renal function usually over hours or days
Chronic renal failure - gradual loss of renal function usually over many years

11

What are the types of causes of renal failure

Pre-renal
Renal
Post-renal

12

What are the pre-renal causes of renal failure

Hypoperfusion of the kidney
Shock
Renal artery or aorta disease
Caused by sudden and severe drop in blood pressure or interruption of blood flow to the kidneys from severe injury or illness

13

What are the renal causes of renal disease

Chronic disease
Drug damage
Trauma
Rhabdomyolysis
Caused by direct damage to the kidneys by inflammation, toxins, drugs, infection or reduced blood supply

14

What are the post-renal causes of renal failure

Renal outflow obstruction
Caused by sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumour or injury

15

What are the signs of acute renal failure

Rapid loss of renal function - creatinine >200umol/L
Anuric initially with volume overload
Ankle oedema or sacral oedema if bed bound
Pulmonary oedema and breathlessness
Raised jugular venous pressure (JVP)
Weight gain
Gradually progresses to polyuria
Development of hypekalaemia (high K+)
Development of uraemia and acidosis

16

What causes acute renal failure and how is it treated

Usually a pre-renal cause
Usually reversible with time
Renal support until recovery - dialysis and nutrition

17

What are the causes of primary renal failure

(Rare)
Glomerulonephritis
Polycistic kidney disease

18

What are the causes of secondary renal failure

Diabetes (30%)
Hypertension (20%)
Drug therapy
Vasculitis
Renal artery disease/aorta disease

19

What are the signs of glomerulonephritis

Haematuria/proteinuria - otherwise healthy individual
Gradual progression to hypertension and chronic renal failure

20

What is nephrotic syndrome and what are the signs

A complication of glomerulonephritis
Excessive loss of protein in the urine - >3g in 24 hours
Loss of plasma oncotic pressure
Oedema
Hypercoagulable state - loss of clotting factors - AT3 deficiency
Dehydration raises other coagulation factor concentrations

21

Which drugs should be avoided in patients with renal disease

NSAIDs - inhibit glomerular blood flow and cause interstitial nephritis
Nephrotoxic drugs - cyclosporin

22

How may renal vascular disease present

Reduced blood flow to the kidney - atheroma of renal arter/aorta or hypertension of the renal artery
Microangiopathy - immune reaction causing small blood vessel damage, RBC damage and thrombosis - E.Coli 0157

23

What are causes of immune mediated renal damage

Multiple myeloma - plasma cell tumour, excess light chain production clogs kidneys - tubular nephritis results
Good pasture’s syndrome - Anti-glomerular basement membrane antibody (anti-gbm)
Vasculitis - SLE and variants

24

What is polycistic disease and what does it cause

Gene mutation (PFD1, 2 or 3)
Can be inherited or spontaneous
Causes multiple cysts in the renal parenchyma
Enlarged kidney
Progressive destruction of normal kidney
Gradual renal failure

25

When is end stage renal disease diagnosed

eGFR <15ml/min
Creatinine 800-1000umol/L

26

What is the normal GFR

90+ml/min

27

How is chronic renal failure managed

Reduce the rate of decline:
Eliminate nephrotoxic drugs
Control hypertension
Control diabetes
Control vasculitis disease
Use of steroids/other immune suppressant drugs
Correct fluid balance - restrict fluid intake, restrict salt, potassium, protein
Correct deficiencies - anaemia (erythropoietin), calcium (Vit D)
Remove outflow obstruction - renal stones or prostate enlargement
Treat infection - chronic renal system infection

28

What are the signs of chronic renal failure

Anaemia
Hypertension
Renal bone disease:
Low Ca, high PO4
Hyperthyroidism
Osteomalacia

29

What are the symptoms of chronic renal failure

Insidious - may be few
Polyuria
Nocturnia
Tired and weak
Nausea

30

What is renal replacement therapy

Replaces the functions of the kidney
Not a cure

31

What are common renal malignancies

Renal cell carcinoma
Transitional cell carcinoma

32

Describe a renal cell carcinoma

Renal tubular cell tumour
Abdominal mass and haematuria
Commoner in men and smokers
Hypertension (renin) and polycythaemia (EPO)

33

Describe a transitional cell carcinoma

Usually bladder - ureter/kidney possible
Haematuria - often asymptomatic

34

What is important in dentistry and renal disease

Check all drugs with renal physician - avoid NSAIDS and some tetracyclines, reduce dose of most others
Growth may be slow in children - tooth eruption may be delayed
Secondary effects of anaemia - oral ulceration, dyaesthesias - painful mucosa and tongue
White patches - uraemia stomatitis
Oral opportunistic infections
Dry mouth and taste disturbance
Bleeding tendencies - platelet dysfunction
Renal osteoid Ts trophy