Renal Medicine

Question 1

What does a urine sample containing cells/protein indicate?

Answer 1

Disease of the glomerulus

Question 2

What does a lack of ADH indicate?

Answer 2

Diabetes Insipidus (peeing a lot)

Question 3

What is Diabetes Insipidus

Answer 3

Large amount of urine produced and feels thirsty

Question 4

Name a kidney function

Answer 4

Lots of fluid reabsorption within the collecting tubules

Question 5

Define polyuria

Answer 5

Excessive/abnormally large production/passage of urine

Question 6

Define dysuria

Answer 6

Painful/difficult urination

Question 7

Define haematuria

Answer 7

The presence of blood in urine

Question 8

Define proteinuria

Answer 8

The presence of excess proteins in the urine (which often causes foamy urine)

Question 9

Define uraemia

Answer 9

A raised level of urea in the blood + other nitrogenous waste compounds that are eliminated by kidneys

Question 10

What are 3 methods used to measure renal function?

Answer 10

1. Serum Urea
2. Serum creatinine
3. 24hr urine collection

Question 11

Which one of the renal function tests is the best?

Answer 11

24hr urine collection

- Creatinine clearance (so best measure)

Question 12

When do serum urea levels rise?

Answer 12

Rise with dehydration

Question 13

What does renal failure lead to? (4)

Answer 13

1. Loss of renal excretory function
2. Loss of water + electrolyte balance
3. Loss of acid base balance
4. Loss of renal endocrine function
   - Erythropoietin
   - Ca+ metabolism
   - Renin secretion

Question 14

How does loss of water/electrolyte balance affect H2O/Na+ levels?

Answer 14

As if you can’t concentrate or modify the electrolytes within the collecting duct system you might lose more H2O/Na+ than you should

Question 15

Function of erythropoietin?

Answer 15

• Controls ability to make RBCs

- If there’s no functioning kidney the bone marrow won’t be asked to make RBCs

Question 16

Where does Ca metabolism occur?

Answer 16

Kidneys

Question 17

Compare:
Acute renal failure
Chronic renal failure

Answer 17

ACUTE RENAL FAILURE:

• Rapid loss of renal function
• Usually over hours/days

CHRONIC RENAL FAILURE:

• Gradual loss of renal function
• Usually over many years

Question 18

List causes of renal failure (3)

Answer 18

1. Pre-renal
2. Renal
3. Post renal

Question 19

How does pre-renal failure occur?

Answer 19

1. Hypoperfusion of the kidney (a reduced amount of blood flow)
2. Shock
3. Renal artery/aorta disease

Question 20

How does renal failure (disease of kidney itself) occur?

Answer 20

Direct damage to kidneys by:

1. Chronic disease
2. Drug damage
3. Trauma
4. Rhabdomyolysis

Question 21

Define rhabdomyolysis

Answer 21

Breakdown of damaged skeletal muscle

Question 22

How does post renal failure occur?

Answer 22

Renal outflow obstruction

Question 23

How does renal outflow obstruction present?

Answer 23

Can be stones or prostate blockage of urinal tract

Question 24

Creatinine levels that indicate acute renal failure

Answer 24

Creatinine > 200umol/L

Question 25

What clinical problems does an acute renal failure cause? (5)

Answer 25

``` Anuric initially: 1. Ankle oedema (if ambulatory) Sacral oedema (if bed bound) 2. Pulmonary oedema + breathlessness 3. Raised jugular venous pressure 4. Weight Gain ``` Gradually progresses to polyuria

Question 26

Acute renal failure can lead to Hyperkalaemia (high K+) why is this a problem?

Answer 26

Can lead to cardiac arrest

Question 27

Acute renal failure can lead to Uraemia + Acidosis, why is this a problem? (3)

Answer 27

1. High urea 2. Low bicarbonate 3. Increased respiratory excretion of CO2 - Raised respiratory rate

Question 28

What is the usual cause for acute renal failure? (2)

Answer 28

- Pre-renal cause | - Usually reversible with time

Question 29

What type of chronic renal failure is rare?

Answer 29

Primary

Question 30

Causes of primary chronic renal failure (2)

Answer 30

1. Glomerulonephritis | 2. Polycystic kidney disease

Question 31

Causes of secondary chronic renal failure (5)

Answer 31

1. Diabetes 2. Hypertension 3. Drug therapy 4. Vasculitis - inflammation of bv's 5. Renal artery disease/aorta disease

Question 32

What is glomerulonephritis?

Answer 32

Inflammation of the glomeruli, which are structures in your kidneys that are made up of tiny blood vessels

Question 33

Name a symptom for glomerulonephritis?

Answer 33

Hypertension

Question 34

Define nephrotic syndrome

Answer 34

Excess loss of protein in the urine >3g

Question 35

Function of NSAIDs (2)

Answer 35

- Inhibit glomerular blood flow | - Cause interstitial nephritis (spaces between kidney tubules become inflamed, so they don't filter properly)

Question 36

What does renal vascular disease cause?

Answer 36

1. Reduced blood flow to the kidney - Atheroma of renal artery/aorta - Hypertension (narrowing of renal artery) 2. Microangiopathy - when the capillaries becomes so thick that they bleed and they leak proteins out

Question 37

What does microangiopathy lead to?

Answer 37

1. Immune reaction causing small blood vessel damage 2. RBC damage 3. Thrombosis

Question 38

Examples of immune mediated renal damage (3)

Answer 38

1. Multiple myeloma 2. Good pastures syndrome 3. Vasculitis 4. Polycystic kidney disease

Question 39

Where are cysts present in polycystic kidney disease? (3)

Answer 39

Multiple cysts in the renal parenchyma - Enlarged kidney - Progressive destruction of normal kidney - Gradual renal failure

Question 40

Indications of end stage renal disease

Answer 40

eGFR < 15ml/min | Creatininine 800-1000umol/L

Question 41

How is chronic renal failure managed? (4)

Answer 41

1. Reduce the rate of decline - Eliminate nephrotoxic drugs - Control hypertension - Control diabetes - Control vasculitic disease 2. Correct fluid balance - Restrict fluid intake - Restrict salt, potassium, protein 3. Correct deficiencies - Anaemia (erythropoietin) - Calcium (vitD) 4. Remove outflow obstruction - Renal stones calculi - Prostate enlargement

Question 42

List signs of chronic renal failure (3)

Answer 42

1. Anaemia 2. Hypertension 3. Renal bone disease - Low Ca, high PO4 - Hyperparathyroidism - Osteomalacia

Question 43

List symptoms of chronic renal failure (5)

Answer 43

1. Insidious 2. Polyuria 3. Nocturia 4. Tired + weak 5. Nausea

Question 44

What does renal replacement therapy mean?

Answer 44

Replaces functions of the kidney but its not a cure

Question 45

Who is a renal cell carcinoma more present in?

Answer 45

Common in men + smokers

Question 46

Where is a transitional cell carcinoma more present?

Answer 46

1. Usually bladder - ureter/kidney possible | 2. Haematuria - often asymptomatic

Question 47

When you have a renal disease patient what should you check/consider? (3)

Answer 47

1. Check all drugs with renal physician 2. Avoid NSAIDs, some tetracyclines 3. Reduce dose of most others

Question 48

Dentistry and chronic renal failure issues

Answer 48

1. Tooth eruption may be delayed 2. Secondary effects of anaemia - Oral ulceration - Dysaesthesias (painful mucosa + tongue) 3. White patches - Uraemia stomatitis

Question 49

Dentistry and renal disease (4)

Answer 49

1. Oral opportunistic infections - Fungal and viral infections/reactivations - Prone to post-op infections 2. Dry mouth + taste disturbance - Fluid restriction and electrolyte disturbance 3. Bleeding tendencies - Platelet dysfunction 4. Renal osteodystrophy - Lamina dura lost - When kidneys fail to maintain proper levels of Ca