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Special Patients > Chapter 7: Dental Treatment For Patients With Kidney Disease > Flashcards

Chapter 7: Dental Treatment For Patients With Kidney Disease Flashcards

1
Q

Chronic kidney disease is?

A

Irreversible and progressive destruction of the nephrons

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2
Q

Glomerular filtration rate in CKD is?

A

< 60ml/min

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3
Q

Function of the kidneys?

A
  • filter blood
  • produce hormones (erithropoeitin)
  • regulate balance of electrolytes, BP
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4
Q

Aetiology of CKD?

A
  • age: 65 years old, men < women
  • unknown
  • kidney disease: chronic nephritis syndromes ,kidney stones
  • intrinsic diseases: diabetes, HBP
  • extrinsic diseases: exposure to silica
  • chronic NSAIDs consumption
  • hereditary factors: amyloidosis-amyloid in tissues
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5
Q

Symptoms of CKD depending on GF?

A
  • 30-50%: slight, no symptoms
  • 20-35%: moderate, high BP, fatigue, anemia, glucose, triglycerides, polyuria
  • 20-25%: severe, metabolic acidosis and edema. Uremic syndrome
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6
Q

What is the final stage of renal failure?

A

Uremic syndrome

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7
Q

Uremic syndrome:

A
  • Disorders of the metabolism of carbohydrates, lipids and proteins
  • Hypertension
  • Congestive heart failure (pericarditis and uremic myocarditis)
  • Gastrointestinal disorder (anorexia, nausea, vomiting)
  • Fetor oris or uremic halitosis due to the release of ammonium
  • Oesophageal and intestinal haemorrhage
  • Anaemia
  • Increase in bacterial infections
  • Alterations of haemostasis
  • Arterial, periarticular and visceral calcification
  • Uremic encephalopathy
  • Dermatological alterations (smooth, pale and distended skin)
    “Uremic frost” is a high concentration of urea in the swear: yellow-green crystals on the skin can be seen. That means a bad prognosis, it is distributed on the tip of the nose, forehead, temporal region and around the hairy foci.
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8
Q

Conservative medical tx of CKD?

A
  • A diet low in proteins
  • Control of sodium (NaCl) and potassium (K)
  • Hypertension, CHF treatment, infections, anaemia, diabetes type II as it is acquired), heart diseases, HBP treatment
  • Avoid nephrotoxicity drugs
  • NSAIDs
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9
Q

2 types of dialysis:

A
  1. Peritoneal dialysis:
    - no need for anticoagulants
    - risk: infection, diabetes, obesity
    - acute: hospital, chronic: at home
  2. Hemodialysis:
    - risk: anticoagulants (heparin), hemorrhage, hepatitis, or HIV
    - inject 3-4 hours/3 days
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10
Q

Risk of kidney transplants?

A

immunosuppressants for a very long time. Interaction/Side effects cause problems in dentistry: hyperplasia, calcifications, and leukopenia.

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11
Q

Oral signs of CKD?

A
  • Dysgeusia, metallic or salty taste
  • Secondary infections: uremic stomatitis
  • Changes in the colour of the mucosa
  • Tongue inflammation
  • Spontaneous gingival bleeding
  • xerostomia—> need artificial saliva
  • Triad: loss of hard lamina, alteration of the trabecular pattern, changes in bone
    density. Renal osteodystrophy.
    a. TMJ alterations
    b. Teeth hyper calcification
    c. Narrow pulp
    d. Enamel hypoplasia
  • Delay in growth and eruption
    Dental pigment:
    a. Intrinsic: tetracyclines (not very common)
    b. Extrinsic: iron
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12
Q

Peritoneal dialysis and controlled patient?

A

Interconsult
- Controlled patient: no risk
- Not controlled: Only emergencies. Severe infections—>hospital.
- Tend to get secondary infections: always going to have antibiotic prophylaxis
- Haemorrhage, anaemia
- High blood pressure
- Xerostomia (tooth decay, PD candidiasis)
- We prefer to do an extraction over an endodontic treatment
- No nephrotoxic medication (NSAIDs, microlites etc.), tetracyclines

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13
Q

Patient with hemodialysis?

A
  • Everything recommended from before
  • Always antibiotics: prophylaxis and endocarditis
  • Due to: anaemia, platelet destruction and heparin:
    a. Hemostatic measures (INR)
    b. Surgery always the day after hemodialysis
  • Always treat as hepatitis or HIV infected
  • No nephrotoxic drugs
  • Extraction is always better in case of doubt
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14
Q

GF < 50ml/min?
GF< 40ml/min?

A
  • GF <50 ml/min—> the kidney does not metabolise drugs well, therefore we should avoid any medication filtrated through the kidney: aspirin, NSAIDs, tetracyclines, acyclovir, and antihistamines.
  • decrease doses, and longer periods between medication: amoxicillin, metronidazole and paracetamol.
  • GF <40 ml/min—> half doses amocillin, ampicillin and penicillin. No need to adjust azithromycin doses.
    Clarithromycin is eliminated by the liver, so we can administer it without problems.
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15
Q

Gold standard drugs in CKD?

A
  • analgesics: codeine + paracetamol
  • sedative: benzos
  • ATB: amoxicllin low doses, azithromycin
  • anaesthetic: low lidocaine doses
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16
Q

Always give ATB in?

A

Kidney transplants

17
Q

Patient with renal insufficiency and dialyzed 3 days a week, he / she visits to make an exodon of p (48) not included. We will carry out the treatment if:

A

a. If 6 hours have passed after dialysis and have been given antibiotic prophylaxis
b. Consultation with your doctor to confirm disease control and medication
c. If we can root it we prefer it to the exodoncia
d. We will perform the exodoncia as long as we do not suture to avoid the risk of foreign body infection
e. We will perform the exodontia 4 hours before dialysis.

B?

18
Q

Renal osteodistrophy is an osseous disorder which the renal patients can have
and it presents:

A

a. dental pigmentation
b. narrow pulp
c. Enamel hypoplasia
d. delay in growth and eruption
e. all of the above arre correct.

E

19
Q

How will we plan the dental treatment of a kidney transplant patient?

A

a. The surgeries will be performed the day after hemodialysis because the patient is more rested.
b. Perform treatments with antibiotic coverage even if there is no infection
c.We will avoid anesthesia with vasoconstrictor
d.Interconsultation to know what treatments we can perform after the transplant
e.The surgeries will be performed the day after hemodialysis, due to the alteration of coagulation by heparin.

B

20
Q

What does it mean for a patient with kidney disease to have a glomerular filtration rate of less than 50ml / min:

A

a. It is necessary to reduce the dose and the time between taking the drugs that we prescribe
b.We are facing a patient with moderate kidney failure
c.We must choose those drugs that the kidney can metabolize
d. We are facing a patient with severe kidney failure
e. It is necessary to decrease the dose and increase the time between taking the drugs that we prescribe

E

Special Patients (9 decks)

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