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?

Treat anemia Signup and view all the answers

What is the primary cause of post-streptococcal glomerulonephritis?

Throat infection by Group A beta hemolytic streptococci Signup and view all the answers

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

Less than 15% of normal GFR remains. Signup and view all the answers

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

End-Stage Renal Disease Signup and view all the answers

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

Diabetes Signup and view all the answers

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

Bone pain Signup and view all the answers

Which of the following can lead to permanent renal failure?

Chronic renal failure Signup and view all the answers

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

Urea secreted in saliva Signup and view all the answers

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

Heart failure Signup and view all the answers

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

Painful plaques on soft tissues Signup and view all the answers

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

Proteinuria greater than 3.5 g/24 h Signup and view all the answers

What is a common clinical feature of poststreptococcal glomerulonephritis?

Tea- or cola-colored urine Signup and view all the answers

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

1-2 weeks Signup and view all the answers

What treatment is primarily provided for patients with poststreptococcal glomerulonephritis?

Systemic antibiotics and supportive care Signup and view all the answers

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

Periorbital and peripheral edema Signup and view all the answers

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.