Renal Disease

kukuhkjhh's version from 2017-05-02 10:00

Section 1

Question Answer
What is Acute renal failure (ARF) ?characterized by sudden loss of kidney function
**What is characteristic of acute renal failure ?Oliguria/Anuria, increased in blood urea nitrogen (BUN) or Increase in serum creatinine
What is oliguria/ anuria ?body is producing small amts. of urine (oliguria) or not producing urine (anuria)
What is chronic renal failure (CRF)?chronic kidney disease= end stage renal disease (ESRD)
What is happening during renal failure ?detonation of NEPHRONS - functioning unit of the kidney
What is the cause of Acute renal failure ?1. diminished RENAL PERFUSION (pre-renal) 2. Glomerular, vascular or tubulointestinal/acute tubular necrosis (renal) 3. Obstruction of uriniary tract (post renal)
What are the DRUGS associated with ARF ?1. Statin drugs 2. NSAIDs 3. Aminoglycosides antibiotics, cocaine, acyclovir, penicillin etc.
T/F oliguria , elevated BUN and creatiinie are apparent in BOTH ARF and CRF ?FALSE - this is only present in ARF
T/F UREMIC SYNDROME can occur in both CRF and ARF ?TRUE
T/F Renal osteodystrophy and uremic peripheral neuropathy occur in both ARF and CRF ?FALSE - only occurs in CHRONIC DISEASE ONLY
What is uremia ? and what does it indicate ?a build up of nitrogenous waste produces in the blood, the products changes how cells function, more uremic they are the more systemic disease they will manifest
If you perform a renal ultrasound, how will you know if you have ARF or CRF ?Normal size kidney = ARF , Shrunken kidney = CRF
CRF= Chronic kidney disease (CKD)= ?ESRD (End stage renal disease)
What eventually happens if you end stage renal disease ?Deterioration of nephrons, broad spectrum of disease processes, and progressive loss of kidney function , and Development of systemic complications such s CARDIOVASCULAR DISEASE
**What is the major cause of death for all people with Chronic kidney disease ?HEART DISEASE
What is the best estimate of kidney function ?Glomerular filtration rate (GFR)
**How are chronic kidney disease and HTN linked ?HTN causes CKD and CKD causes HTN
What indicates that a patient has chronic kidney disease?Persistant proteinuria (protein in the urine) means CKD is present
**What are the HIGH RISK groups for CKD?AA, Hispanics, Pacific islanders, Native americans and seniors
**What 3 simple tests can detect CKD ?1. Blood pressure 2. urine albumin (or urinalysis) 3. serum creatinine (metabolic panel)
T/F there are multiple stages of kidney disease true
*** what are the 3 MAIN reasons patients have renal disease ??1. DM >> 2. HTN > 3. Chronic glomerular nephritis

Section 2

Question Answer
What is the basic pathophysiology of renal disease ?REPEATED INJURY to kidney
What is the more detailed pathophysiology of renal disease ?CHRONIC VASOCONTSTRICTION - Ischemia - Reduced GFR- OLIGURIA
What are symptoms of renal disease 1. hematuria 2. flank pain 3. edema 4. HTN 5. signs of uremia 6. lethargy and fatigue 7. loss of appetite 8. elevated serum creatinine
What is a sign of renal disease that you will see in the dental chair ?Ammonia breath bc they have urea in their saliva, for caries it increases pH and is bactericidal so they have less caries
What is the basis of diagnosis chronic kidney disease ?defined as either kidney damage or GFR < 60 ml/min
What does the urinalysis tell us ?hematuria or proteinuria
What does the renal function test tell you ?creatine clearance test- inulin clearance test
What is the serology for a patient with renal disease ?1. Serum ALBUMIN is HIGH 2. PTH is HIGH 3. K is usually HIGH 4. Calcium is HIGH
*** look at chat with systemic manifestation

Section 3

Question Answer
What is the medical management for MILD renal disease ?DIET MODIFICATION 1. sodium bicarbonate to reduce acidosis 2. Vit. D to treat hypocalcemia 3. High CARB/ Low Protein diet
What is the medical management for ADVANCED renal disease ?Dialysis
What is the reason for High carb/ low protein diet in MILD renal disease ?To minimize the toxic nitrogenous products produced by protein metabolism
What is BEANS ?B= BP maintained lower than 130/85 E= Erythropoietin treatment to maintain hemoglobin at 10-12g/dl / A- access for dialysis created when serum creatainie reaches >4mg/dl / N- nutritional status monitoring / S- Specialty evaluation by a nephrologist when serum creatine > 3.0mg/dl
When should dialysis start?when serum creatine reaches >4.0 mg/dl
What is the hemoglobin renal disease patients should try and maintain ?10-12 g/dl
What should a renal disease patient have specialty evaluation by a nephrologist ?when serum creatine is >3.0mg/dl
What is dialysis ?Artificial process that removes NITROGENOUS and other waste products of metabolism from the blood
T/F Dialysis replaces normal kidney function ?FALSE doesn't produce Vit D or erythropoietin
What are the 2 types of dialysis ?1. peritoneal dialysis 2. Hemodialysis (more common)
What is Peritoneal dialysis ?Access to body via catheter through abdominal wall, Peritoneal membrane serves as "filter"
What are the advantages of using peritoneal dialysis ?1. slower than hemodialysis 2. used for SHORT term 3. Allows patient greater ambulatory ability
What % of dialysis is peritoneal dialysis ?20%
What is hemodialysis ?Access to blood via ARTERY-VENUS shunts and fistulas (arm/leg/neck) and the dialyzer contains semi-permeable membrane to filter fluid and wastes /// 3x a week for 3-4hours a day
What is vascular access ? connect and artery and a vein
What % of renal patients have oral manifestations ?90%
What are the oral manifestation of renal disease ?1. Halitosis/metallic taste 2. xerostomia and retrograde parotitis 3. pallor of the oral mocha secondary to anemia 4. uremic stomatitis and uremic frost (bc there is so much urea that would get mouth sores) and uremic frost is crystals in saliva that show up on mucosa and mouth is so dry and it looks like frost in the mouth
When will you see renal ostedystrophy ?apparent in end stage disease and dialysis
What are the 3 causes of renal osteodystrophy ?1. Disorders of CALCIUM and PHOSPHOROUS metabolism 2. Abnormal VIT D Metabolism 3. Increased PTH activity
What are dental findings in RENAL OSTEODYSTROPHY ?1. "ground glass" bone 2. decreased trabeculation 3. loss of lamina dura 4. radiolucent giant cell lesions 5. tooth mobility 6. malocclusion 7. enamel hypoplasia 8. pulp stones 9. sclerotic bone in extraction healing sites 10. delayed/altered dental eruption
*****What are the concerns when you are managing these renal disease patients ?1. excessive bleeding 2. HTN/Hypotension 3. Anemia 4. Drug intolerance and synergism 5. Increased susceptibility to infection 6. oral manifestations
What are the HEMATOLOGIC considerations when working with renal disease patients ?1. ANTI-COAGULATION during dialysis treatments 2. Mechanical trauma to platelets ( 17% decrease) during dialysis treatments 3. Platelet destruction/dysfunction with uremia 4. ANEMIA secondary to uremia and volume changes with dialysis treatments
Why do renal disease patients have a risk of infection?1. altered cellular immunity 2. malnutrition 3. systemic bactermia leading to increased risk of IE 3. local - yeast infection , perio disease 4. INFECTIVE ENDOCARDITITIS
What % of patients on hemodialysis get Infective endocarditis ?2.7% of patients during hemodialysis / 9% of patients with a history of an infection of the vascular access site
What bug accounts for 17% of IE ?streptococcus viridians
How are the pharmacotherpeutics changed for patients on dialysis ?PLASMA HALF LIVES ARE PROLONGED in CKD and REDUCED with hemodialysis ( have to time it appropriately)
What will you have to alter when concerning the drugs for patients on dialysis ?have to change the "DOSE INTERVAL" -- not the dose
What is the therapeutic regimen for prescribing medications for dialysis patients ?NARROW range for therapeutic regimen (AVOID toxicity)/ Avoid sub-therapeutic dosing / AVOID nephrotoxic drugs