Dental Mgmt of Pts w Renal Disease Flashcards
1
Q
2 types of dialysis:
A
hemodialysis, peritoneal
2
Q
Cause of acute renal failure:
A
sudden interruption of bood supply
3
Q
3 possible sites of interruption of blood supply to the kidney:
A
prerenal, intrinsic, post-renal
4
Q
Cause of prerenal acute renal failure:
A
sever volume depletion and/opr dec renal perfusion
5
Q
Prerenal volume depletion leads to:
A
renal losses, GI losses, cutaneous losses, hemorrhage, pncreatitis
6
Q
Exs of cutaneous losses (volume depletion):
A
burns, Stevens-Johnson syndrome)
7
Q
Examples of renal losses:
A
diuretics, polyuria
8
Q
These can lead to prerenal kidney failure:
A
heart failure, pulmonary embolus, acute MI, severe valvular disease
9
Q
Cause of intrinsic acute renal failure:
A
cytotoxic, ischemic, or inflammatory assault, structural and functional damage within the kidney
10
Q
Narcotics can lead to this type of kidney failure:
A
acute
11
Q
Can lead to post-renal acute renal failure:
A
obstruction of passage of urine
12
Q
These can lead to the obstruction of the passage of urine:
A
stones, tumors, fibrosis, obstruction from crystals
13
Q
Drugs that can induce renal obstruction via the formation of crystals:
A
acyclovir, methotrexate
14
Q
TF? Acute renal failure is rarely reversible.
A
F. often reversible
15
Q
Prognosis of acute renal failure is related to:
A
cause and duration
16
Q
% of people with chronic renal disease 10y after acute renal failure:
A
25%
17
Q
% of ppl on dialysis 10y after acute renal failure:
A
12%
18
Q
Fraction of ppl that survive acute renal failure that does not have kidney failure 10y later:
A
2/3
19
Q
% of adult US population w chronic renal disease:
A
15% (32 million)
20
Q
% of ppl over the age of 70 with chronic renal disease:
A
50%
21
Q
Define chronic renal disease:
A
structural or functional kidney abnormalities that persists for at least 3mo
22
Q
Chronic renal disease leads to:
A
destruction of renal mass w irreversible sclerosis and loss of nephrons
23
Q
TF? GFR does not always decrease in chronic renal failure.
A
F. progressive decline
24
Q
Chronic or end stage renal disease usually progresses form:
A
mild disease (renal insufficiency)
25
% of nephrons not working in renal failure:
less than 50%
26
What is end stage renal disease:
not working enough to sustain life
27
Why is end stage renal disease increasing by 8% every year?
bc it is assoc w other diseases that are increasing rapidly
28
Can chronic renal disease lead to CV disease?
yes
29
Uremia due to kidney failure can lead to:
anemia, bleeding, HTN, fluid imbalance, altered drug metabolism
30
Stage 1 chronic renal disease:
kidney damage w normal or increased GFR (>90 mL/min/1.73 m^2)
31
Stage 2 chronic renal disease:
mild reduction in GFR (60-89 mL/min/1.73 m^2)
32
Stage 3 chronic renal disease
moderate reduction in GFR (30-59 mL/min/1.73 m^2)
33
Stage 4 chronic renal disease:
Severe reduction in GFR )15-29 mL/min/1.73 m^2)
34
Stage 5 chronic renal disease:
Kidney failure (GFR <15 mL/min/1.73 m^2 or dialysis)
35
Risk factors/. causes of chronic renal disease:
diabetes, DV disease, liver failure, inherited diseases (polycystic kidney disease)
36
End stage renal disease at a young age is most likely a result of:
polycystic kidney disease
37
Fraction of pts w Dm that will develop renal failure
1/3
38
% prevalence of diabetes:
12%
39
Leading cause of chronic renal disease:
DM
40
% of kidney that DM accounts for:
45%
41
1 in __ adults w HTN will develop kidney disease:
1 in 5
42
HTN lead to:
vessel damage, reduced renal blood supply, interstitial damage
43
Can HTN be a complication of chronic renal disease?
yes
44
How can renal failure lead to HTM?
damaged kidneys can't regulate Bp as well
45
Most important risk factor for diabetic to develop kidney disease:
`HTN
46
TF? HTN can be either a cause or effect of kidney disease/
T
47
High systemic pressure for diabetic pts means it is more/less like to get renal failure.
more
48
Top 2leading causes of kidney failure:
diabetes, high blood pressure
49
Top 6 reasons for renal failure in pts over 65:
diabetes, HTN, other glom-nephritis, urologic, cysitc
50
Other risk factors for chronic renal failure:
endocarditis, Hep B and C, syphilis, HIV, parasitic infection, heroin
51
Can a person recover from 1 hit acute heroin overdose?
yes
52
Kidney functions:
Filter waste from bloodstream, electrolye balance, fluid balance, drug metabolism, toxin removal, drug metabolism, toxin removal , hormone secretion
53
Hormones secreted from the kidneys regulate:
BP, Ca+ metabolism, RBC production
54
Hormone released from kidneys that regulates BP:
Renin
55
Hormone released from the kidneys that controls Ca+ metabolism:
Calcitrol
56
Hormone secreted by kidney that control BC production:
erythropoietin
57
Risk factor and affect of kidney disease:
BP
58
Normal GFR:
>9 ml/min/1.73 m^2
59
GFR of disease kidney:
< 60L:
60
GFR of kidney failure:
<15
61
Units for GFR:
volume/ min/ surface area
62
diseased state for kidney is what fraction of normal
2/3
63
BUN sf:
Blood urine nitrogen
64
Urea nitrogen comes from;
protein breakdown
65
Does BUN inc or dec as kidney function decreases?
increases
66
Normal BUN:
7-20 mg/dll
67
Waste product of muscle metabolism:
serum creatinine
68
How do serum creatinine levels vary?
race, age, body mass
69
Normal serum creatinine:
0.6-1,2 mg/dl
70
TF? Serum creatinine levels are lower in females.
T
71
Serum creatinine level that indicates end stage disease:
>10 mg/dl
72
Inc/ dec creatinine, dec kidney function:
inc
73
This ratio indicates level and location of dysfunction:
Bun: creatinine ratio
74
This tells you likely site of problem in kidney:
relative kidney function
75
Bun:Cr >20:1 :
Prerenal issue, BUN reabsorption is increased. BUN is disproportionately elevated in relation to creatinine in serum
76
BUN: CR ratio: 10-20:`1:
Normal to posternal issue, normal range, can also be postrenal disease, BUN reabsorption is w/in normal limits
77
BUN: CR ratio: <10:1
Intrarenal, Renal damage, renal damage causes reduced reabsorption of BUN, therefore lowering BUN:Cr ratio
78
Urea:Cr 40-100:1:
Normal to posternal issue, normal range, can also be postrenal disease, BUN reabsorption is w/in normal limits
79
Urea:Cr: >100:1:
Prerenal issue, BUN reabsorption is increased. BUN is disproportionately elevated in relation to creatinine in serum
80
Urea <40:1:
Intrarenal, Renal damage, renal damage causes reduced reabsorption of BUN, therefore lowering BUN:Cr ratio
81
TF? You want GFR and BUN to be high and creatinine to be low.
F. GFR high, BUN and Creatinine to be low
82
Other tests of renal function:
`ultrasound, CT, biopsy, urinalysis, creatinine clearance
83
CT can be used for this in renal failure:
postrenal obstruction, tumors, masses
84
Creatinine clearance:
urodynamic test, sequential series of lab tests to see actual clearance of creatinine over time
85
Sequelae of end stage renal disease:
Uremea, fluid overload/TN, CV disease, azotemia
86
What is azotemia:
nitrogen in bloodstream-metabolic acidosis (electrolyte imbalance)
87
What is uremea:
excess urea and creatinine in blood
88
Symptoms of azotemia:
hyperventilation, fatigue, nausea, diminished reserve, hematologic problems, renal osteodystrophy, neurologic involvement, uremic stomatitis (aspirin burn-like)
89
What causes hyperventilation in end stage renal disease:
Pulmonary system trying to compensate for renal system
90
Hematologic problems related to end stage renal disease
anemia, WBC dysfunction, coagulopathy
91
Renal osteodystrophy:
skeletal malformations, hormone involved in bone remodeling secondary hyperparathyroidism osteomalacia, osteofibrosis, osteosclerosis, bone metabolism is affected
92
Neurologic involvement related to end stage renal disease:
depression, psychosis, convulsive disorders - body overwhelmed by toxins
93
Uremic stomatitis:
uncommon, may be accompanied by burning and taste alterations, assoc w inc ammonia compounds in saliva
94
Tx for end stage renal disease:
hemodialysis, periotoneal (another part of your body)dialysis, transplant
95
THere are __X as many ppl on hemodialysis than transplant recipients:
2
96
When to schedule appts for pts on hemodialysis:
either MWF or T TH S
97
Why is vascular surgery done for any pt on dialysis?
in order to speed flow of venous flow, artery connected to vein
98
Hemodialysis is:
AV fistula-surgical anastomsis of artery and vein, bypassing capillaries
99
Wks it takes for hemodialyis to mature:
4-6wks
100
How many needles are inserted during dialysis?
2 needles
101
What is prone to infection in pts on hemodialysis?
AV fistula
102
Drug used during dialysis:
Heparin, to prevent clotting
103
How many hours after dialysis do we have to wait before we treat at UB?
We don't treat the same day as dialysis
104
Peritoneal dialysis:
membrane around intestines acts as filter, dialysis fluid is instilled around membrane and dialysis occurs by diffusion, excess fluid can be removed by osmosis by altering glucose concentration in fluid, catheter in pts abdomen from peritoneum to surface near naval,
105
Is the risk of infection higher or lower for peritoneal dialysis compared to hemodialysis?
lower
106
Type of machine used or peritoneal dialysis:
none
107
Most common type of peritoneal dialysis:
continuous ambulatory peritoneal dialysis (CAPD)
108
Time per day CAPD is done:
4
109
continuous peritoneal dialysis, machine or no machine?
machine
110
When is continuous peritoneal dialysis typically performed?
while sleeping
111
TF? Some forms of intermittent peritoneal dialysis are done while sleeping.
T
112
Typical site for peritoneal dialysis catheter:
stomach
113
Advantages of peritoneal dialysis:
can be done at home, easy to learn/ travel with, fluid balance is easier than hemodialysis
114
1st choice tx of kidney failure if transplant is not available:
peritoneal dialysis
115
Disadv, peritoneal dialysis:
requires attention to cleanliness while performing, infection, addition of fluid too quickly (leaks into surrounding tissue, hernias due to abdominal fluid load)
116
Possible consequences of addition of fluid too quickly in peritoneal dialysis:
fluid leaks into surrounding tissue, hernias due to abdominal fluid load
117
More expensive, peritoneal dialsis or hemodialysis in end stage renal disease?
hemodialysis
118
How many tmes more likely are hemodialysis pts likely to be hospitalized?
2 X
119
Less sick ppl, hemodialysis or peritoneal dialysis?
peritoneal
120
What should be screened for with pts with renal failure/ dialysis?
bleeding disorders (platelet count and function, Hb, Hct)
121
Blood screening tests to get for pts with renal failure/ dialysis:
platelet count, Hb, Hct
122
Why ppl have bleeding disorders:
erythropoietin stim hormone dec (lower red count, likely to bleed bc of platelet fxn, dialysis reduces platelet fxn,)
123
Main determinant of uremic bleeding in end stage renal disease and dialysis:
platelet function
124
Is platelet count normally low or high in end stage renal disease?
low
125
What causes decreased platelet function in end stage renal disease:
dec platelet aggregation, impaired platelet adhesiveness
126
Dec platelet function leads to:
dec platelet glycoproteins, uremic toxins, anemia
127
Platelets adhere to these at the endothelial cell surface;
subendothelial collagen receptors exposed at injury site
128
Cx man of impaired platelet function in end stage renal disease:
bruising, prolonged bleeding in response to injury , gingival bleeding and epitaxis possible but not common, inc sensitivity to aspirin
129
word for bleeding from the nose:
epitaxis
130
Questions to ask f a person starts bleeding from their nose at dental appt:
Hypervascualr septum? on dialysis? spontaneous bleeding?
131
Why is anemia common in end stage renal disease?
due to dec erythropoetin production
132
How to improve platelet function in end stage renal disease:
correction of anemia:
133
How to correct anemia in end stage renal disease:
transfusions, Erythropoetin stimulating agent (common for dialysis pts)
134
Where to take BP for pts on dialysis:
side opposite the port/ shunt
135
How to manage infections in the oc for pts with renal failure/ dialysis:
aggreessively
136
Avoid these drugs for pts w renal failure/ dialysis:
nephrotoxic drugs
137
How might prescribing be different for pts w renal failure/ dialysis?
adjust dosages or inc intervals
138
Drugs to avoid for pts with renal failure/ dialysis (RF/D):
ASA, acyclovir, NSAIDs, ketoconazole (antifungal)
139
Inc dose intervals of these drugs for pts with RF/ D:
penicillins, cephalosporins, tetracyclin
140
Can penicillins, cephalosporins, or tetracyclins be metabolized by pts with RF/ D?
yes, but more slowly
141
Drugs that are ok to use for pts with RF/ D:
narcotics, erythromycins, acetominophen
142
Can narcotics be used for pregnant women?
yes
143
TF? acetaminophenis hepatotoxic.
T. pts can burn liver if taking in excess
144
Why to treat pts on non-dialysis days:
bc of anticoagulation during dialysis
145
Drug used during dialysis;
heparin
146
1/2 life of heparin:
2-4hr
147
TF? You should consider antibiotic prophylaxis for pts on hemodialysis.
T, less common lately, consult physician
148
Benefit of antibiotics for pts on hemodialysis:
dec rate of bacteremia, dec need for catheter removal 2' to complications, may lead to antimicrobial resistnace
149
Wy do pts on hemodialysis need prophylaxis for dental procedures?
bc of the presence of an arteriovenous shunt for dialysis, shunt infection, risk of infective endocarditis
150
% of AV shunts that become infected:
22% (3.2/100 pts-mo)
151
Complications of AV shunt infection;
IE and death
152
% of cases of AV shunt infection that require heart valve replacement:
25%
153
% of normal GFR that indicates need for renal transplant;
<20 % normal
154
Contraindications for renal transplants:
cardiac and pulmonary insufficiency, liver failure, Hep C, HIV, active cancer, noncompliance
155
Most common cause of renal transplant:
Dm
156
Are most pts on dialysis prior to transplant?
yes
157
Pts are typically in one of these 2 stages of renal disease before being put on dialysis:
4 or 5
158
% of kidney donors that re living donors in the US:
50%
159
TF? A very close MHC match is very critical for kidney transplant pts;
F. Not anymore, better anti-rejection drugs
160
What happens to the failed kidney when a pt needs a transplant?
left in place, donor kidney placed in lower abdomen
161
Avg life span of donor kidney:
10-15y (he said yr)
162
Acute kidney rejection occurs in what % of pts w/in how many days of the transplant?
10-25%, w/in 60d
163
How long does a pt ith a kidney transplant have to stay on immunosuppressive drugs?
forever
164
Immunosuppressive drugs used after kidney transplant:
mycophenolate, prednisone, cyclosporin, tacrolimus
165
Mycophenolate is aka:
CellCept
166
Pts taking CellCept are also taking:
cyclosporin and corticosteroids
167
Adverse affects of Mycophenolate (CellCept):
abdominal pain, anemia, diarrhea, fever, HTN, infection, pharyngitis, resp tract infection, sepsis, oportunisticinfection
168
What is cyclosporin:
immunosuppressive drug w potent effects on response of T-lymphocytes and cell-mediated immunity
169
Uses of cyclosporin:
rejection of transplants, psoriasis, RA
170
Adverse effects of cyclosporin:
candidiasis, *gingival overgrowth, tremors, headache, HTN, Hepatotoxicity, nephrotoxicity
171
Precautions to take for pts taking cyclosporin:
momnitor vital signs, place on freq recall
172
Symptoms pts that are taking cyclosporin may have:
dyscrasias - infection, bleeding, and poor healing
173
Should prophylactic antibiotics be given to pts taking cyclosporin?
usually recommended for pts wth organ transplant and immunosuppression, request consult for blood studies and baseline Bp
174
Tests to request for pt w organ transplant and immunosuppression:
blood studies, baseline BP
175
Precautions for prednisone:
pregnancy category C, diabetes, glaucoma, osteopoosis, seizure disorders, ulcerative colitis, HF, myasthenia gravis, renal disease, esophagitits, peptic ulcer, rifampin, drug interactions
176
Dental considerations for pts taking prednisone:
monitor vital signs, avoid aspirin, blood dyscrasias, symptoms of oral infection may be masked, freq recall visits
177
Pts that may require supplemental sterois for dental treatment:
pts who have been or are currently on chronic steroid therapy greater than 2 wks
178
This can lead to adrenal insufficiency:
heavy hitting immunosuppressant
179
Adverse effects of prednisone:
candidiasis, dry mouth, oor wound healing, petechiae, depression, mood changes, GI hemorrhage, pancreatitis, increased appetite, thrombocytopenia, fungal infections, osteoporosis
180
Common location for petechiae hemorrhaging in pts taking prednisone:
buccal mucosa
181
An edentulous pt taking prednisone can generate enough force to:
cause bleeding of the ridges
182
Should we consider propylactic antibody tx for pts who have had a kidney transplant?
yes
183
How to treat infections for pts with kidney transplant:
aggressively
184
Big side effect of immunosuppressants taken for rental transplants:
adrenal suppression w steroids
