Renal Diseases Overview

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Questions and Answers

Which of the following is NOT a soft tissue change related to uremic stomatitis?

Petechiae and ecchymosis

Gingival hyperplasia (correct)

Xerostomia

Burning mouth

What is a potential consequence of oxalosis on dental health?

Increased tooth mobility (correct)

Increased enamel strength

Decreased root resorption

Delayed tooth eruption

Which oral manifestation is associated with hyperparathyroidism?

Urine-like breath odor

Ground glass appearance of bone (correct)

Xerostomia

Gingival hyperplasia

Which treatment is NOT typically used for chronic renal failure?

Increase dietary protein intake Signup and view all the answers

Post-streptococcal glomerulonephritis (PSGN) is primarily caused by which organism?

Group A beta hemolytic streptococci Signup and view all the answers

What is one primary clinical feature of nephritic syndrome?

Oliguria and azotemia Signup and view all the answers

Which age group is most commonly affected by poststreptococcal glomerulonephritis?

Children aged 3-12 years Signup and view all the answers

What type of infection is commonly associated with the onset of poststreptococcal glomerulonephritis?

Group A β-hemolytic streptococcal infections Signup and view all the answers

What is a common urine finding in nephritic syndrome?

Presence of RBC casts Signup and view all the answers

What is the general treatment approach for poststreptococcal glomerulonephritis?

Supportive care and fluid restriction Signup and view all the answers

What percentage of normal GFR indicates significant renal failure?

Less than 15% Signup and view all the answers

Which of the following conditions is the most common cause of chronic kidney disease in developed countries?

Diabetes Signup and view all the answers

Which stage of chronic renal failure involves a significant loss of renal function leading to permanent renal failure?

End-Stage Renal Disease Signup and view all the answers

Which of the following symptoms is NOT commonly associated with chronic renal failure?

Severe headache Signup and view all the answers

What is the process through which urea secreted in saliva leads to oral manifestations in chronic renal failure?

It is converted into ammonia by oral microflora. Signup and view all the answers

Which of the following is a characteristic symptom of Uremic Stomatitis caused by chronic renal failure?

Painful plaques and crusts Signup and view all the answers

What type of renal failure is typically potentially reversible?

Acute renal failure Signup and view all the answers

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

Acute injury of the kidneys Signup and view all the answers

Study Notes

Renal Diseases

A significant loss of renal function in both kidneys, where less than 15% of normal glomerular filtration rate (GFR) remains, defines renal failure.
A GFR test is a blood test that assesses kidney function.
Renal failure can be acute (rapidly progressing) or chronic (progressive loss of function over years).
Acute renal failure is potentially reversible.
Chronic renal failure can lead to permanent damage.
Chronic renal failure is a result of progressive kidney damage and function loss.

Stages of Chronic Renal Failure

Chronic renal failure is categorized into four progressive stages based on decreasing GFR.
The stages are:
- Diminished renal reserve
- Renal insufficiency
- Renal failure
- End-stage renal disease

Causes of Chronic Renal Failure

Diabetes is the most common cause in developed countries.
Chronic infections
Prolonged renal obstruction.
Exposure to toxic chemicals or toxins.
Drugs (e.g., aminoglycoside antibiotics).
Hypertension.
Nephrosclerosis (atherosclerosis of the renal artery).
Polycystic kidney disease.

Symptoms of Chronic Renal Failure

Anemia
Dry skin
Loss of appetite
Vomiting
Bone pain
Metallic taste in the mouth
Headaches
Inability to concentrate urine
Polyuria/oliguria
Edema
GFR decreases from 90 to 30 mL/min
Increased serum potassium
Increased blood pressure (BP)
Weakness and fatigue

Uremic Stomatitis

Soft tissue changes are caused by urea in saliva, urease enzyme produced by oral microflora and free ammonia which damages oral mucosa.
Changes include painful plaques and crusts on buccal mucosa, dorsum of tongue, and floor of mouth with gray pseudo membrane exudate and painful ulcers.
Further complications include bleeding diathesis (petechiae and ecchymosis), irritation and chemical injury of mucosa (ammonium compounds), xerostomia (unpleasant taste), burning mouth, and uriniferous breath odor.
Other ulcer causes include anemia and viral infections (immunosuppressed).
Gingival hyperplasia can be caused by cyclosporine and nifedipine (CCB).

Hard Tissue Changes (Uremic Stomatitis)

Tooth staining is caused by iron supplements.
Reduced dental caries is caused by urea in saliva.
Delayed tooth eruption.
Enamel hypoplasia.
Oral manifestations of oxalosis include alveolar bone resorption, external root resorption, increased tooth mobility, pain, and an open bite.

Oral Manifestations in Hyperparathyroidism

Teeth appear more radiopaque against a background of osteoporotic bone.
Loss of bony trabeculations.
Ground-glass appearance.
Total or partial loss of lamina dura.
Loss of cortical outlines of inferior alveolar sinus.
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)

Caused by group A beta-hemolytic streptococci (GAHS) serotype 12, 4, 1 from throat or skin infections.
Antibodies to streptococcus (anti-streptolysin O) are formed in the circulation.
Antigen-antibody immune complexes are deposited at the glomerular basement membrane.

Nephritic Syndrome (PSGN)

Nephritic syndrome is characterized by;
- Hematuria with acanthocytes
- RBC casts in the urine.
- Proteinuria (< 3.5 g/24 h)
- Hypertension.
- Oliguria
- Azotemia
This syndrome indicates glomerular inflammation.

Clinical Features of Poststreptococcal Glomerulonephritis

Occurs weeks after group A β-hemolytic streptococcal infections.
Pharyngitis/tonsillitis is the most common cause (1-2 weeks after infection).
Skin infections (3-4 weeks after infection).
Periorbital and peripheral edema.
Hypertension.
Tea- or cola-colored urine.
In Children, typically self-limiting.
Can lead to rapidly progressive glomerulonephritis (RPGN) → renal insufficiency in adults.

Signs and Symptoms of Glomerulonephritis

Headache.
Facial/periorbital edema.
Lethargic
Low-grade fever.
Weight gain.
Proteinuria.
Hematuria.
Oliguria.
Dysuria

Investigations of PSGN

Urine analysis.
Serology (antibody testing).
Throat swab.
Renal function tests.

Treatment of Poststreptococcal Glomerulonephritis

Supportive care, fluid, and sodium restrictions.
Diuresis within 7-10 days of symptom onset.
10 days of systemic antibiotic treatment with penicillin V.

References and Further Readings

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

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Description

This quiz covers the key concepts of renal diseases, focusing on renal failure and its stages. It discusses the importance of GFR testing and the causes leading to chronic renal failure. Test your knowledge on this critical health topic.