3. Chronic Kidney Disease Flashcards
What is the definition of chronic kidney disease and what is it assocaited with?
- Progressive, asymptomatic decline in renal function for >3 months
- Associated with decreased GFR (<60mL/min) or urine albumin-creatinine ratio >30mg/g
How common is CKD?
- More than 10% of people have it
- More than 35% of people older than 20 with diabetes
- More than 20% of people older than 20 with HTN
- More common in women
Define the 5 stages and their associated values of Chronic Kidney Disease.
- At risk - >60 (with risk factors)
- Stage 1 - >90 kidney damage with normal or elevated GFR
- Stage 2 - 60-89 kidney damage with mildly decreased GFR
- Stage 3 - 30-59 moderately decreased GFR
- Stage 4 - 15-29 severely decreased GFR
- Stage 5 - <15 (or dialysis) kidney failure
What are the possible signs of decreased GFR?
- >90 - asymptomatic
- 60-90 may have hematuria or proteinuria
- 30-60 may develop anemia, secondary hyperparathyroidism
- 15-30 start to prep for dialysis or transplant
- <15 initiate dialysis in DM, 10 in non-DM
What are some common causes of CKD?
- Diabetis mellitus
- Hypertension
- Glomerulonephritis
- Polycystic Kidney Disease
- Drug-induced
What are the main risk factors for progression of CKD?
- Uncontrolled diabetes
- Uncontrolled hypertension
- Repeated episodes of acute kidney injury
- *CKD more common in women, but men 50% more likely to progress to End stage renal disease
What are the consequences of kidney disease?
- Anemia
- Abnormal bleeding
- Electrolyte and fluid imbalance
- Hypertension
- Drug intolerance
- Skeletal abnormalities
- Increased susceptibility to infection
What are the general signs and symptoms?
- Ill feeling, malaise, nausea, fatigue, anorexia, headaches, loss of apetite, weight loss
- Anemia, insomnia, nocturia, insomia
- Bone pain, GI symptoms
- Uremic symptoms
- Cognitive delay, depression, psychosis at later stages
- Peripheral neuropathy, muscular hyperactivity, seizures
- Increased bleeding tendency
What lab finding are we interested in for CKD patients?
- GFR
- Urine analysis
- Creatinine level - measures muscle breakdown and filtration capacity
- Creatinine clearance
- Hemoglobin/hematocrit
What are some oral manifestations of CKD?
- Candidiasis
- Gingivitis
- Periodontal disease
- DMFT
- Pallor of oral mucosa
- Xerostomia
- Metallic taste
- Uremic stomatitis (severe renal failure)
- Oral mucosal lesions
What are the 4 primary principles of dental management in CKD patients?
- Ability to withstand dental care
- Ability to achieve hemostasis
- Susceptibility to infection
- Drug-drug interactions/dosage modifications
What does ability to withstand dental care refer to?
- Presence of cardiovascular disease?
- Controlled/uncontrolled?
- Assess for specific cardiovascular disease risk
Since CKD patients are at an increased risk for bleeding, what should the platelet count and hematocrit levels be at?
- For normal
- Platelet count - > 50,000
- Hematocrit levels > 25%
Since CKD patients are more susceptible to infections, what should their absolute neutrophil count be?
- Needs to be greater than 500/mm3 - may require antibiotic prophylaxis (consult with physician)
- In un-controlled patients, may consider appropriate use of post-op antibiotics
What is important regarding the drug-drug interactions in CKD patients?
- Dosage modification
- GFR < 50
- Drugs are excreted half as efficiently
- Need to follow renal dosing guidelines
- Avoid nephrotoxic drugs
- Aspirin, NSAIDS
- ESRD
- Evaluate hemoglobin and hematocrit levels prior to nitrous administrations
- General anesthesia
- Need to assess hemoglobin levels
