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Questions and Answers
Which symptom is NOT associated with uremic stomatitis in chronic renal failure?
Which symptom is NOT associated with uremic stomatitis in chronic renal failure?
What is the primary characteristic of the hard tissue changes seen in chronic renal failure?
What is the primary characteristic of the hard tissue changes seen in chronic renal failure?
Which of the following oral manifestations is linked to hyperparathyroidism?
Which of the following oral manifestations is linked to hyperparathyroidism?
What is a potential consequence of oxalosis in the oral cavity?
What is a potential consequence of oxalosis in the oral cavity?
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What is the causative agent of post-streptococcal glomerulonephritis?
What is the causative agent of post-streptococcal glomerulonephritis?
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What is a common symptom of nephritic syndrome?
What is a common symptom of nephritic syndrome?
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Which urinary feature is indicative of glomerular inflammation in nephritic syndrome?
Which urinary feature is indicative of glomerular inflammation in nephritic syndrome?
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What is the typical onset period for symptoms following a streptococcal throat infection leading to poststreptococcal glomerulonephritis?
What is the typical onset period for symptoms following a streptococcal throat infection leading to poststreptococcal glomerulonephritis?
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Which treatment approach is primarily indicated for poststreptococcal glomerulonephritis?
Which treatment approach is primarily indicated for poststreptococcal glomerulonephritis?
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What color is the urine typically described as in patients with poststreptococcal glomerulonephritis?
What color is the urine typically described as in patients with poststreptococcal glomerulonephritis?
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What is the primary definition of renal failure?
What is the primary definition of renal failure?
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Which of the following is NOT one of the stages of chronic renal failure?
Which of the following is NOT one of the stages of chronic renal failure?
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What is the most common cause of chronic kidney disease in developed countries?
What is the most common cause of chronic kidney disease in developed countries?
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Which of the following symptoms is typically associated with chronic renal failure?
Which of the following symptoms is typically associated with chronic renal failure?
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What is one of the causes of chronic renal failure related to prolonged obstruction?
What is one of the causes of chronic renal failure related to prolonged obstruction?
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Which of the following best describes uremic stomatitis?
Which of the following best describes uremic stomatitis?
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What happens to oral mucosa in uremic stomatitis?
What happens to oral mucosa in uremic stomatitis?
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Which of the following best describes chronic renal failure?
Which of the following best describes chronic renal failure?
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Study Notes
Renal Diseases
- Renal failure is 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.
- Acute renal failure is potentially reversible.
- Chronic renal failure can lead to permanent renal failure.
- Chronic renal failure is the end result of progressive kidney damage and loss of function.
Stages of Chronic Renal Failure
- Chronic renal failure is classified into four progressive stages, based on the 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 of chronic kidney disease in developed countries.
- Chronic infections.
- Prolonged renal obstruction.
- Exposure to toxic chemicals, toxins, or drugs (aminoglycoside antibiotics).
- Hypertension.
- Nephrosclerosis (atherosclerosis of the renal artery).
- Polycystic kidney disease.
- Hydronephrosis (urinary tract dilation).
Symptoms of Chronic Renal Failure
- Anemia.
- Dry skin.
- Loss of appetite.
- Vomiting.
- Bone pain.
- Metallic taste in mouth.
- Headaches.
- Inability to concentrate urine.
- Polyuria/oliguria.
- Edema.
- GFR progressively decreases from 90 to 30 ml/min
- Increased serum potassium.
- Increased blood pressure.
- Weakness and fatigue.
Uremic Stomatitis
- Soft tissue changes: urea secreted in saliva, urease enzyme produced by oral microflora, which liberates free ammonia, damages oral mucosa.
- Painful plaques and crusts on buccal mucosa, dorsum of tongue, and floor of mouth, with gray pseudo membrane exudate and painful ulcers.
- Bleeding diathesis (petechiae and ecchymosis).
- Irritation and chemical injury of mucosa (ammonium compounds).
- Xerostomia (unpleasant taste).
- Burning mouth.
- Uriniferous breath odor.
- Ulcers secondary to anemia and/or viral infection (immunosuppressed).
- Gingival hyperplasia (Cyclosporine and Nifedipine (CCB))
Hard Tissue Changes
- Staining in teeth (iron supplements).
- Reduced caries (urea in saliva).
- Delayed teeth eruption.
- Enamel hypoplasia.
- Tooth mobility (oral manifestations of oxalosis include alveolar bone resorption and external root resorption).
- Increased tooth mobility.
- Pain.
- Open bite.
Oral Manifestations in Hyperparathyroidism
- Teeth appear more radiopaque in background of osteoporotic bone.
- Loss of trabeculation of bone.
- Ground glass appearance.
- Total or partial loss of lamina dura.
- Loss of cortical outlines of inferior alveolar sinus cortex of mandible.
- Pulpal calcifications.
- Multilocular radiolucency.
- Arterial and oral calcification.
Treatment of Chronic Renal Failure
- Careful management of fluids and electrolytes.
- Restriction of dietary protein intake.
- Treatment of anemia.
- Renal dialysis.
- Renal transplantation.
Post-streptococcal Glomerulonephritis (PSGN)
- Cause: Group A beta-hemolytic streptococci (GAHS) serotype 12,4,1.
- Pathogenesis: Throat/skin infection by GAHS, antibodies to streptococcus (anti-streptolysin O) are formed in the circulation, antigen-antibody immune complexes are deposited in glomerular basement membrane.
- Nephritic syndrome is an inflammatory process characterized by hematuria with acanthocytes and RBC casts in urine, proteinuria (< 3.5 g/24 h), hypertension, oliguria, and azotemia.
Clinical Features of PSGN
- Occurs weeks after group A beta-hemolytic streptococcal infections.
- Periorbital and peripheral edema.
- Hypertension.
- Tea- or cola-colored urine.
- Usually self-limiting in children.
Investigations
- Urine analysis.
- Serology.
- Throat swab.
- Renal functions.
Treatment of PSGN
- Mainly supportive care, restriction of fluid and sodium.
- Diuresis within 7-10 days after onset of symptoms.
- 10 days of systemic antibiotic with penicillin V.
References
- AMBOSS.
- Harrison's Principles of Internal Medicine 20th edition (ISBN-13: 978-1259644030).
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Description
This quiz covers the critical aspects of renal diseases, focusing on the stages of chronic renal failure and its causes. Understand the impacts of renal failure, including acute and chronic conditions, along with their potential reversibility. Test your knowledge of kidney function measurement and the significance of glomerular filtration rate (GFR).
