Dentistry Human Disease > Renal Disease > Flashcards

Renal Disease Flashcards

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1
Q

What are five causes of urinary tract obstruction?

A
  1. Renal stones/calculi
  2. Tumours (prostatic malignancy)
  3. Prostatic hypertrophy
  4. Urinary tract strictures (following damage)
  5. External compression
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2
Q

What is the cause of most urine infections?

A

Bacterial contamination from the skin around the urethra

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3
Q

Why are urinary tract infections more common in woman than men?

A

Anatomically women have shorter urethras so its easier for bacterial contamination of the perineum to spread into the urine

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4
Q

What is the most common bacteria (85% of the time) involved in urinary tract infections?

A

E.coli

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5
Q

What is cystitis?

A

Bladder inflammation

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6
Q

What are predisposing factors to cystitis?

A
  • poor bladder emptying
  • low urinary flow rates
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7
Q

What are the 5 main symptoms of a UTI?

A
  • dysuria (pain on passing urine)
  • urinary frequency
  • cloudy urine
  • offensive smelling urine
  • supra-pubic pain
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8
Q

What can be three outcomes of infected urine?

A
  • cystitis
  • renal infection
  • prostate infection
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9
Q

If there is reflux of infected urine into the urethra, what can result from this?

A

Renal (Kidney) infection

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10
Q

When might urethritis occur in isolation?

A

Presence of gonococcal infection (if patient has gonorrhoea)

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11
Q

How would you diagnose a UTI?

A
  • Through MID-stream urine sampling (MSSU)
  • microscopy, culture and sensitivity
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12
Q

How would you treat a UTI?

A
  • increase fluid intake
  • frequent micturation
  • occasionally antibiotics required
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13
Q

How might prostate disease make passage of urine more difficult, in men?

A

Enlargement of the prostate gland is going to compress the urethra and make passage of urine more difficult

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14
Q

Define inflammation of the prostate.

A

Prostatitis

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15
Q

Define, hyperplasia of the prostate gland.

A

Benign prostatic hypertrophy

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16
Q

What are the symptoms of urine outflow obstruction?

A
  • slow stream
  • hesitancy
  • frequency
  • urgency
  • nocturnal
  • incomplete voiding
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17
Q

What are the treatment options for benign prostatic hypertrophy?

A
  • initially drug based
  • surgery
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18
Q

What drugs are used to treat benign prostatic hypertrophy and why?

A
  • alpha blocking drugs (shrink gland size)
  • anticholenergics (shrink gland size)
  • diuretics ( help flush through urinary problem)
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19
Q

What surgery is used for benign prostatic hypertrophy?

A

Prostatectomy

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20
Q

What are the risks of prostatectomy?

A
  • incontinence
  • erectile dysfunction
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21
Q

What screening test is now recommended for prostate cancer?

A

MpMRI

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22
Q

What are the three treatments for prostatic malignancy?

A
  • surgery (radical prostatectomy)
  • radiotherapy
  • hormone treatment
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23
Q

What drugs are used in hormone treatment for prostatic malignancy, and what is their function?

A
  • anti-androgens & LHRH analogues
  • block hormone-dependant tumour growth
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24
Q

What two parts of the body can renal calculi form?

A
  • in the kidney
  • in the bladder
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25
In what situation can renal calculi be extremely painful?
When they are trapped in ureters passing between the kidney and bladder
26
What are the two types of renal stones? State if they are radio-opaque or not.
- calcium and oxalate (radiopaque) - Uric acid ( not radiopaque)
27
What procedure is used to treat renal calculi?
Lithotripsy
28
How does lithotripsy work?
Treats renal stones by sending focused ultrasonic energy or shock waves directly to the stone to break it down so it can pass through the urinary system
29
What is meant by, polyuria?
Passing of a large volume of urine
30
What is meant by, dysuria?
Pain on passing urine
31
What is meant by haematuria?
Blood present within the urine
32
What is meant by proteinuria? And what can thus suggest?
Protein passing into the urine. This can be suggestive of glomerular disease.
33
What is glomerular disease?
A condition that can damage your kidneys, the disease attacks the filters in you kidneys known as glomeruli.
34
What is meant by uraemia?
Increased concentration of urea within the blood
35
What is the modern, quick way of looking at renal function based on urea and electrolyte measurements?
EGFR- estimated Glomerular filtration rate
36
What factors are lost upon renal failure?
- loss of renal excretory function - loss of water and electrolyte balance - loss of acid base balance - loss of renal endocrine function
37
What characterises acute renal failure?
Rapid loss of renal function usually over hours or days
38
What characterises chronic renal failure?
Gradual loss of renal function usually over many years
39
What is a pre-renal cause of renal failure?
Hypoperfusion (reduced amount of blood flow) to the kidney
40
What are the direct problems with the kidney itself (intra renal) that can cause renal failure?
- chronic disease - drug damage - trauma - rhabdomyolysis (damages muscle tissue releases proteins and electrolytes into the blood)
41
What are the post-renal causes of renal failure?
Renal outflow obstruction
42
What are the potential consequences of acute renal failure?
1. Initially, kidneys do not produce urine (Anuria) resulting in volume overload (associated oedema) 2. Gradually progresses to polyuria 3. Hyperkalaemia (high K+) which can lead to cardiac arrest 4. Development of uraemia (high urea) and acidosis, results in raised respiratory rate.
43
What is the most likely cause of acute renal failure?
Pre-renal, such as hypovolemia.
44
Name 7 risk factors for chronic renal disease?
- diabetes - high blood pressure - heart disease - obesity - family history - age 60+ - smoker
45
What are the two primary causes of chronic renal failure?
- glomerulonephritis - polycystic kidney disease (PKD)
46
What is glomerulonephritis?
Also known as glomereulus. Inflammation and damage to the filtering part of the kidneys.
47
What are the secondary causes of chronic renal failure?
- diabetes - hypertension - drug therapy - vasculitis - renal artery disease/aorta disease
48
What are the most common causes of chronic renal failure?
- diabetes - hypertension
49
What is a complication of glomerulonephritis that involves excessive loss of protein in the urine, such as hypoalbuminaemia?
Nephrotic syndrome
50
What drugs make renal disease worse?
- NSAIDs (inhibit glomerular blood flow and causes interstitial nephritis) - Nephrotoxic drugs (e.g. cyclosporine)
51
What conditions are caused by immune mediated renal damage?
- multiple myeloma - good pastures syndrome - vasculitis
52
Mutation if what genes can cause polycystic kidney disease?
PKD1,2, or 3
53
What eGFR measurement and creatinine levels would suggest end stage renal disease?
EGFR = <15ml/min Creatinine = 800-1000 micromol/L
54
Anyone below what eGFR measurement is considred to have impaired renal function?
<60 ml/min
55
What would be a eGFR reading for someone with normal or minimal renal damage?
90+ml/min
56
How could you reduce the rate of chronic renal failure decline?
- eliminate nephrotoxic drugs - control hypertension - control diabetes - control vasculitis disease
57
How could you correct fluid balance when managing chronic renal failure?
- restrict fluid intake - restricts salt, potassium, protein
58
What are the signs of chronic renal failure?
- anaemia - hypertension - renal bone disease
59
What are the symptoms of chronic renal failure?
- insidious (may be few) - polyuria - nocturia - tired and weak - nausea
60
What is the purpose of renal replacement therapy?
Replaces function of the kidneys
61
What are the two types of renal malignancies that can occur?
- renal cell carcinoma - transitional cell carcinoma
62
What dental effect can chronic renal failure have in children?
Tooth eruption may be delayed due to slow growth
63
What are secondary oral effects of anaemia from chronic renal failure?
- oral ulceration - painful mucosa and tongue (dysaeshesias)
64
Name 4 dental effects of renal disease?
1. More prone to oral opportunistic infections 2. Dry mouth and taste disturbance 3. Bleeding tendencies (platelet dysfunction) 4. Renal osteodystrophy causing loss of lamina duration and bony radiolucencies
65
What is renal dialysis?
“The process of removing excess water,solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally.”
66
What are the two types of renal dialysis?
1. Haemodialysis 2. Peritoneal dialysis
67
What is haemodyalisis?
Where the blood is taken out of the body and applied through a dialysis unit, then returned to the body
68
What is Peritoneal dialysis?
Where the dialysing solution is introduced into the peritoneal cavity and the inner lining of the peritoneum is used as the dialysis membrane.
69
What is the main advantage of peritoneal dialysis over haemodyalsis?
Peritoneal dialysis is portable, in haemodyalsis the patient is restricted to the hospital or to their home to have the dialysis carried out.
70
What are the two main hormones secreted by renal endocrine function?
- erythropoietin (EPO) - renin
71
What are the benefits of renal endocrine replacement?
- can replace erythropoietin by injections, so maintains red cell mass - maintains bone mass by supplementing vitamin D - aims to control hypertension so to reduce the rate at which renal disease progresses
72
What is the optimal treatment option for end stage renal disease?
Renal transplantation
73
How does the location of a transplanted kidney differ from a normal kidney?
Normal kidneys are difficult to access at the back for the abdominal cavity, therefore the transplanted kidney is placed lower in the abdomen where it is much easier to connect to the vascular and urinary systems
74
On a biopsy, what would be indicative of rejection of a transplanted kidney?
Lost of lymphocytes in the glomerulus attacking the new kidney
75
At what time is it best to treat a patient on haemodialysis? Is this the same for peritoneal dialysis?
The day after the dialysis session. No this is not necessary for peritoneal dialysis patients.
76
Why is it nit appropriate to treat a patient while they are on dialysis?
They are at greater risk of excessive bleeding and infection
77
Name 4 key immunosuppressant drugs used throughout life once an individual has had a kidney transplant?
1. Prednisolone 2. Azathioprene 3. Tacrolimus 4. Cyclosporine
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