Ch 54 Organ Transplantation And Renal Disease

Question 1

Organ transplantation and renal disease: Gingival enlargement causes

Answer 1

-cyclosporine increases risk of nephrotoxicity
-most transplant recipients are trusted with trio of immunosuppressants
-gingival enlargement is an adverse reaction associated with immunosuppressive therapy

Question 2

Immunosuppressive therapy is at its most aggressive level in transplant recipients when

Answer 2

Immediately after transplant surgery

Question 3

Candidiasis and viral infection

Answer 3

Common in patients receiving immunosuppressive therapy
-oral healthcare provider works with transplant team to determine appropriate Trx

Question 4

Trx after solid organ transplantation

Answer 4

Immediately after transplantation only emerg dental care is recommended
-during stable post transplant phase following actions are indicated:
-consult with and obtain clearance from physician to confirm pt is stable enough to receive dental Trx
-meticulous osc
-necessary professional oral care
-frequent oral debridement
-frequent oral hygiene counselling
-regular screening for oral, head and neck cancer

Question 5

Malignancies

Answer 5

-organ transplant recipients have an increased risk of squamous and basal cell carcinoma
-frequently screen skin and oropharyngeal area
-liver transplant recipients with history of tobacco use and or alcoholism are at particular risk for oropharyngeal cancer

Question 6

Renal disease

Answer 6

-pts with end stage renal disease can use dialysis as “bridge to transplantation”
-kidney transplants can be provided by a living donor
-decreased kidneys have a 48 hour window
-increased number of kidney transplant recipients and candidates exist

Question 7

Renal physiology

Answer 7

Kidneys perform 3 essential bodily functions
-excretion of nitrogenous waste products
-regulation of fluid volume, composition and acid base balance of plasma
-synthesis of hormones necessary for erythrocyte production, bone metabolism and maintenance of blood pressure

Question 8

Chronic renal failure or CKD causes

Answer 8

Gradual loss of ability of kidneys to remove water, concentrate urine and conserve electrolytes

Question 9

Stages of chronic kidney disease

Answer 9

-stage 1: renal damage with normal GFR
-stage 2: renal damage with mild decrease in GFR
-Stage 3: moderate decrease in GFR
-stage 4: severe reduction in GFR
-stage 5: end stage renal disease

Question 10

Several systematic factors increase risk for developing chronic kidney disease (CKD)

Answer 10

-diabetes mellitus
-high blood pressure
-cardiovascular disease
-obesity
-family history of CKD

Question 11

End stage renal disease (ESRD)

Answer 11

-when kidney stop functioning, dialysis or solid organ transplant is needed to sustain one’s life
-dialysis treatment method of cleaning and filtering wastes and toxins from blood when kidneys lose their function in ESRD

Question 12

Medical treatment modalities for end stage renal disease (ESRD) include

Answer 12

In center hemodyalysis
- home hemodialysis
- peritoneal dialysis
-renal transplantation

Question 13

Dialysis Trx modalities: dental hygiene considerations

Answer 13

-alterations in the dental hygiene care plan for the person receiving hemodialysis texts include the following:
-consulting with and obtaining clearance from pts nephrologist
-confirming that the patient is medically stable enough to receive dental Trx
-determining the need for prophylactic antibiotic premed
-not taking blood pressure reading in the dialysis access arm
-avoiding dental Trx if dialysis Trx has been performed on the same day

Question 14

Periodontal disease and renal insufficiency

Answer 14

-moderate relationship exists between periodontal disease and renal insufficiency
-risk for periodontal disease appears to be significantly increased in individuals with severe renal disease or in patients receiving hemodialysis texts include
-frequent 3-4 months continued care interval appointments are recommended