Renal Diseases and Chronic Renal Failure
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Questions and Answers

Which of the following is NOT a soft tissue change associated with uremic stomatitis?

  • Petechiae and ecchymosis
  • Xerostomia
  • Uriniferous breath odour
  • Gingival hyperplasia (correct)
  • What oral manifestation may occur due to oxalosis potentially leading to increased tooth mobility?

  • Delayed teeth eruption
  • External root resorption (correct)
  • Pulpal calcifications
  • Tooth staining
  • In patients with hyperparathyroidism, which of the following is an oral manifestation that indicates loss of bone structure?

  • Increased caries
  • Ground glass appearance of bone (correct)
  • Oral calcifications
  • Teeth appearing more radiopaque
  • Which treatment is specifically aimed at managing anemia in chronic renal failure?

    <p>Treat anemia (C)</p> Signup and view all the answers

    What is the primary cause of post-streptococcal glomerulonephritis?

    <p>Throat infection by Group A beta hemolytic streptococci (B)</p> Signup and view all the answers

    What defines renal failure concerning glomerular filtration rate (GFR)?

    <p>Less than 15% of normal GFR remains. (B)</p> Signup and view all the answers

    Which stage of chronic renal failure represents the final stage before complete kidney failure?

    <p>End-Stage Renal Disease (D)</p> Signup and view all the answers

    What is the most common cause of chronic kidney disease in developed countries?

    <p>Diabetes (D)</p> Signup and view all the answers

    Which symptom is associated with chronic renal failure due to uremia?

    <p>Bone pain (C)</p> Signup and view all the answers

    Which of the following can lead to permanent renal failure?

    <p>Chronic renal failure (B)</p> Signup and view all the answers

    What is the main cause of Uremic Stomatitis in chronic renal failure?

    <p>Urea secreted in saliva (C)</p> Signup and view all the answers

    Which of the following is not a cause of chronic renal failure?

    <p>Heart failure (D)</p> Signup and view all the answers

    Which of the following is a manifestation seen in Uremic Stomatitis?

    <p>Painful plaques on soft tissues (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic sign of nephritic syndrome?

    <p>Proteinuria greater than 3.5 g/24 h (A)</p> Signup and view all the answers

    What is a common clinical feature of poststreptococcal glomerulonephritis?

    <p>Tea- or cola-colored urine (D)</p> Signup and view all the answers

    What is the typical time frame for the onset of poststreptococcal glomerulonephritis after a pharyngeal infection?

    <p>1-2 weeks (B)</p> Signup and view all the answers

    What treatment is primarily provided for patients with poststreptococcal glomerulonephritis?

    <p>Systemic antibiotics and supportive care (C)</p> Signup and view all the answers

    In nephritic syndrome, what type of edema is commonly observed?

    <p>Periorbital and peripheral edema (B)</p> Signup and view all the answers

    Flashcards

    Renal Failure

    Significant loss of kidney function, where less than 15% of normal GFR remains.

    Acute Renal Failure

    A rapidly progressing kidney function loss that is potentially reversible.

    Chronic Renal Failure

    Progressive loss of kidney function over time; permanent.

    Chronic Kidney Disease Stages

    Progressive stages based on decreased GFR: diminished reserve, insufficiency, failure, and end-stage renal disease.

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    Causes of Chronic Kidney Disease

    Diabetes, chronic infections, prolonged renal obstruction, toxic exposure, hypertension, nephrosclerosis, and polycystic kidney disease.

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    Uremic Stomatitis

    A condition in chronic kidney disease characterized by oral sores and inflammation.

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    Symptoms of Chronic Kidney Disease

    Anemia, dry skin, poor appetite, vomiting, bone pain, and a metallic taste in the mouth.

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    Uremic Stomatitis Cause

    Urea in saliva, acting as a source for ammonia accumulation, producing pain and damaging the oral mucosa.

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    Uremic Stomatitis - Soft Tissue Changes

    Oral manifestations of chronic renal failure affecting soft tissues. Includes bleeding, petechiae, ecchymosis, irritation, xerostomia, bad taste, burning mouth, and uremic breath odor.

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    Uremic Stomatitis - Ulcers

    Uremic Stomatitis can lead to ulcers due to anemia and increased susceptibility to viral infections in the immunocompromised state.

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    Gingival Hyperplasia - Uremic Stomatitis

    Overgrowth of gums in Uremic Stomatitis can be caused by medications like cyclosporine and nifedipine.

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    Hard Tissue Changes - Uremic Stomatitis

    Uremic Stomatitis can affect hard tissues of the mouth, including teeth staining, reduced caries, delayed eruption, enamel hypoplasia, and tooth mobility.

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    Oxalosis - Oral Manifestations

    Oxalosis can cause alveolar bone resorption and external root resorption, resulting in increased tooth mobility, pain, and open bite.

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    Nephritic Syndrome

    An inflammatory process in the kidneys, marked by hematuria with acanthocytes, red blood cell casts in urine, proteinuria (less than 3.5g/24h), hypertension, oliguria, and azotemia.

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    Poststreptococcal Glomerulonephritis

    An inflammatory kidney condition that occurs weeks after a group A β-hemolytic streptococcal infection, usually affecting children aged 3-12 and elderly patients.

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    Clinical Features of Poststreptococcal Glomerulonephritis

    Symptoms include periorbital and peripheral edema, hypertension, tea- or cola-colored urine. It usually resolves on its own in children, but can lead to rapidly progressive glomerulonephritis (RPGN) and kidney failure in adults.

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    Investigations for Poststreptococcal Glomerulonephritis

    Diagnostic tests include urinalysis, serology, throat swab, and renal function tests.

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    Treatment for Poststreptococcal Glomerulonephritis

    Treatment is primarily supportive, including fluid and sodium restriction. Diuretics may be used, and antibiotics such as penicillin V are prescribed for 10 days.

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    Study Notes

    Renal Diseases

    • Renal diseases are a broad category encompassing various conditions affecting the kidneys.
    • The presentation covers acute and chronic renal failure, their causes, symptoms, treatment, and specific types like post-streptococcal glomerulonephritis (PSGN).

    Renal Failure

    • Defined as a significant loss of kidney function, where less than 15% of normal glomerular filtration rate (GFR) remains.
    • GFR is a blood test measuring kidney function.
    • Kidney disease progresses from normal GFR (120) to 60, then ultimately to kidney failure at 0.
    • Acute renal failure may be reversible, while chronic failure leads to permanent damage.
    • Chronic renal failure is a progressive loss of renal function over years, resulting from progressive kidney damage.

    Stages of Chronic Renal Failure

    • Chronic renal failure stages are based on a progressive loss of GFR.
    • Stages include diminished renal reserve, renal insufficiency, renal failure, and end-stage renal disease.

    Causes of Chronic Renal Failure

    • Diabetes is the most common cause in developed countries.
    • Chronic infections can also lead to renal failure.
    • Prolonged renal obstruction, exposure to toxins, certain drugs (aminoglycoside antibiotics), hypertension, nephrosclerosis (atherosclerosis of the renal artery), and polycystic kidney disease contribute to chronic renal failure.

    Symptoms of Chronic Renal Failure

    • Symptoms include anemia, dry skin, poor appetite, vomiting, bone pain, metallic taste in the mouth, headaches, inability to concentrate urine, polyuria/oliguria, increased blood urea nitrogen (BUN) along with serum creatinine, edema, decreased GFR (from 90 to 30 ml/min), elevated serum potassium (K), high blood pressure (BP), weakness, and fatigue.

    Uremic Stomatitis

    • A soft tissue change characterized by urea in saliva, urease enzyme production by oral microflora, formation of free ammonia, and damage to the oral mucosa.
    • Oral manifestations include painful plaques/crusts on buccal mucosa, dorsum of tongue, and floor of mouth, with gray exudate and ulcers.
    • Other soft tissue changes include bleeding diathesis (petechiae and ecchymosis), irritation of mucosa (ammonium buildup creating unpleasant taste), xerostomia, a burning mouth sensation, and a uriniferous breath odour.
    • Ulcers can be secondary to conditions like anemia or viral infections (immunosuppressed).
    • Gingival hyperplasia is associated with medications like cyclosporine and nifedipine.

    Hard Tissue Changes in Chronic Renal Failure

    • Hard tissue changes include staining of teeth (from iron supplements), reduced tooth decay (due to urea in saliva), delayed tooth eruption, enamel hypoplasia, tooth mobility, alveolar bone/root resorption leading to increased pain and an open bite.

    Oral Manifestations in Hyperparathyroidism

    • In hyperparathyroidism, teeth appear more radiopaque against the background of osteoporotic bones.
    • Other signs include loss of trabeculations of bone, ground glass appearance, loss of lamina dura, loss of cortical outlines of the inferior alveolar sinus and cortex of mandible, and calcification of the pulp.
    • Multilocular radiolucency and calcification in arteries and oral tissues can also occur.

    Treatment of Chronic Renal Failure

    • Treatments for chronic renal failure primarily involve careful management of fluids and electrolytes, restriction of dietary protein intake, treatment of anemia, renal dialysis, and renal transplantation.

    Post-streptococcal Glomerulonephritis (PSGN)

    • PSGN occurs weeks after group A beta-hemolytic streptococcal infections (such as pharyngitis/tonsillitis or skin infections).
    • Symptoms include periorbital and peripheral edema, hypertension, tea- or cola-colored urine, and often are self-limiting in children.
    • However, these can progress to rapidly progressive glomerulonephritis (RPGN) leading to renal insufficiency in adults.

    Signs and Symptoms of PSGN

    • General symptoms include headache, elevated blood pressure (BP), facial/periorbital edema, lethargy, low-grade fever, increased weight due to edema, proteinuria, hematuria, oliguria, dysuria (difficulty urinating), and various urine color changes.

    Investigations

    • Investigate PSGN with urine analysis, serology tests, throat swabs, and renal function tests.

    Treatment of PSGN

    • Primarily involve supportive care, fluid and sodium restriction, diuresis within 7-10 days post-symptom onset, and 10 days of antibiotic treatment with penicillin V.

    References and Further Reading

    • AMBOSS
    • Harrison's Principles of Internal Medicine, 20th edition (ISBN-13: 978-1259644030)

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    Description

    This quiz focuses on renal diseases, exploring acute and chronic renal failure, their causes, symptoms, and treatment options. It delves into the stages of chronic renal failure and measures of kidney function such as GFR. Test your knowledge on kidney health and its critical conditions.

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