Chronic Kidney Disease Flashcards
chronic kidney disease
progressive loss of renal fxn persisting >3 months
causes of chronic kidney disease
- diabetes
- hypertension
- chronic glomerulonephritis
- polycystic kidney disease
what percent of chronic kidney disease is caused by diabetes?
37%
what percent of chronic kidney disease is caused by hypertension?
24%
pathophysiology of chronic kidney disease
- progressive destruction/deterioration of nephrons
- hypertrophy of remaining nephrons to compensate
homeostasis is preserved until what percent of nephron destruction?
> 50%
*can go without symptoms until then
what is used to diagnose and monitor chronic kidney disease
glomerular filtration rate (GFR)
glomerular filtration
process by which kidneys filter blood to remove excess waste and fluid
glomerular filtration rate (GFR)
a calculation to determine how well the blood is filtered by the kidneys
what is the best measure of overall fxn of kidneys?
GFR
clinical presentation of early disease
asymptomatic
what leads to symptoms of chronic kidney disease?
- nitrogenous waste builds up in blood
- kidneys perform fewer excretory, endocrine, and metabolic fxns
how many chronic kidney disease stages are there?
5
stage 1 of chronic kidney disease
normal kidney fxn
what percent of kidney fxn do pts in stage 1 have?
90-100%
*pts at high risk of developing chronic kidney disease and need testing
stage 2 chronic kidney disease
mild kidney fxn
what percent of kidney fxn do pts in stage 2 have?
60-89%
at what stage of CKD are pts symptomatic?
stage 3
stage 3 chronic kidney disease
moderate kidney fxn
what percent of kidney fxn do pts in stage 3 have?
30-59%
stage 4 chronic kidney disease
severe kidney fxn
what percent of kidney fxn do pts in stage 4 have?
15-29%
stage 5 chronic kidney disease
kidney failure
what percent of kidney fxn do pts in stage 5 have?
0-14%
medical management of CKD pts
- conservative care
- dialysis
- kidney transplant
conservative care is a way to medically manage pts in which stage of CKD?
stages 1 & 2 (GFR>60)
what does conservative care consist of?
- decrease nitrogenous waste retention (modified diet to decrease protein intake)
- control HTN, fluids, electrolyte imbalance by limiting fluid, sodium, potassium intake
- correct/control diabetes, HTN, chronic HF, hyperparathyroidism
dialysis is for pts in what stage?
stage 5 but sometimes 4
*GFR <30 decision made on case by case basis
dialysis
artificial blood filtration
pts with what GFR must be under dialysis?
<15%
percent of pts that do peritoneal dialysis (dialysis at home)
20%
what is the decision to start hemodialysis?
GFR + clinical presentation
how often is hemodialysis?
every 2-3 days, 3-4 hours per session
are pts sick in between sessions of dialysis?
no, pts live a normal life relatively
what percent of normal renal fxn does hemodialysis provide?
only 15%
what is the best day to txt pts for dental care?
day after dialysis
what is surgically created in the forearm of dialysis pts?
AV fistula/graft
what does the AV fistula/graft allow?
- good access
- good blood flow
can we use the AV fistula/graft to check BP?
NO, only for urologist to use
dental management of CKD pts that are conservatively managed
- no contraindications to routine dental care but consult physician
- avoid/adjust dosage of nephrotoxic drugs and those excreted by kidneys if GFR <60
what are common dental drugs CKD pts should avoid?
- NSAIDS
- Tylenol
why is Tylenol nephrotoxic when the liver metabolizes it?
because kidney excretes it
dental management of CKD pts on hemodialysis
- physician consultation
- dental txtment on day after dialysis
- avoid nephrotoxic drugs and those metabolized by kidney
- no BP cuff on AV shunt
is antibiotic prophylaxis indicated for CKD pts on hemodialysis?
no, will get out of system at next dialysis session
