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Evaluating the Medically Complex Patient > Dental Mgmt of Pts w Renal Disease > Flashcards

Dental Mgmt of Pts w Renal Disease Flashcards

1
Q

2 types of dialysis:

A

hemodialysis, peritoneal

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2
Q

Cause of acute renal failure:

A

sudden interruption of bood supply

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3
Q

3 possible sites of interruption of blood supply to the kidney:

A

prerenal, intrinsic, post-renal

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4
Q

Cause of prerenal acute renal failure:

A

sever volume depletion and/opr dec renal perfusion

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5
Q

Prerenal volume depletion leads to:

A

renal losses, GI losses, cutaneous losses, hemorrhage, pncreatitis

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6
Q

Exs of cutaneous losses (volume depletion):

A

burns, Stevens-Johnson syndrome)

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7
Q

Examples of renal losses:

A

diuretics, polyuria

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8
Q

These can lead to prerenal kidney failure:

A

heart failure, pulmonary embolus, acute MI, severe valvular disease

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9
Q

Cause of intrinsic acute renal failure:

A

cytotoxic, ischemic, or inflammatory assault, structural and functional damage within the kidney

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10
Q

Narcotics can lead to this type of kidney failure:

A

acute

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11
Q

Can lead to post-renal acute renal failure:

A

obstruction of passage of urine

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12
Q

These can lead to the obstruction of the passage of urine:

A

stones, tumors, fibrosis, obstruction from crystals

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13
Q

Drugs that can induce renal obstruction via the formation of crystals:

A

acyclovir, methotrexate

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14
Q

TF? Acute renal failure is rarely reversible.

A

F. often reversible

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15
Q

Prognosis of acute renal failure is related to:

A

cause and duration

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16
Q

% of people with chronic renal disease 10y after acute renal failure:

A

25%

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17
Q

% of ppl on dialysis 10y after acute renal failure:

A

12%

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18
Q

Fraction of ppl that survive acute renal failure that does not have kidney failure 10y later:

A

2/3

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19
Q

% of adult US population w chronic renal disease:

A

15% (32 million)

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20
Q

% of ppl over the age of 70 with chronic renal disease:

A

50%

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21
Q

Define chronic renal disease:

A

structural or functional kidney abnormalities that persists for at least 3mo

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22
Q

Chronic renal disease leads to:

A

destruction of renal mass w irreversible sclerosis and loss of nephrons

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23
Q

TF? GFR does not always decrease in chronic renal failure.

A

F. progressive decline

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24
Q

Chronic or end stage renal disease usually progresses form:

A

mild disease (renal insufficiency)

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25
Q

% of nephrons not working in renal failure:

A

less than 50%

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26
Q

What is end stage renal disease:

A

not working enough to sustain life

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27
Q

Why is end stage renal disease increasing by 8% every year?

A

bc it is assoc w other diseases that are increasing rapidly

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28
Q

Can chronic renal disease lead to CV disease?

A

yes

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29
Q

Uremia due to kidney failure can lead to:

A

anemia, bleeding, HTN, fluid imbalance, altered drug metabolism

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30
Q

Stage 1 chronic renal disease:

A

kidney damage w normal or increased GFR (>90 mL/min/1.73 m^2)

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31
Q

Stage 2 chronic renal disease:

A

mild reduction in GFR (60-89 mL/min/1.73 m^2)

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32
Q

Stage 3 chronic renal disease

A

moderate reduction in GFR (30-59 mL/min/1.73 m^2)

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33
Q

Stage 4 chronic renal disease:

A

Severe reduction in GFR )15-29 mL/min/1.73 m^2)

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34
Q

Stage 5 chronic renal disease:

A

Kidney failure (GFR <15 mL/min/1.73 m^2 or dialysis)

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35
Q

Risk factors/. causes of chronic renal disease:

A

diabetes, DV disease, liver failure, inherited diseases (polycystic kidney disease)

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36
Q

End stage renal disease at a young age is most likely a result of:

A

polycystic kidney disease

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37
Q

Fraction of pts w Dm that will develop renal failure

A

1/3

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38
Q

% prevalence of diabetes:

A

12%

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39
Q

Leading cause of chronic renal disease:

A

DM

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40
Q

% of kidney that DM accounts for:

A

45%

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41
Q

1 in __ adults w HTN will develop kidney disease:

A

1 in 5

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42
Q

HTN lead to:

A

vessel damage, reduced renal blood supply, interstitial damage

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43
Q

Can HTN be a complication of chronic renal disease?

A

yes

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44
Q

How can renal failure lead to HTM?

A

damaged kidneys can’t regulate Bp as well

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45
Q

Most important risk factor for diabetic to develop kidney disease:

A

`HTN

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46
Q

TF? HTN can be either a cause or effect of kidney disease/

A

T

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47
Q

High systemic pressure for diabetic pts means it is more/less like to get renal failure.

A

more

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48
Q

Top 2leading causes of kidney failure:

A

diabetes, high blood pressure

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49
Q

Top 6 reasons for renal failure in pts over 65:

A

diabetes, HTN, other glom-nephritis, urologic, cysitc

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50
Q

Other risk factors for chronic renal failure:

A

endocarditis, Hep B and C, syphilis, HIV, parasitic infection, heroin

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51
Q

Can a person recover from 1 hit acute heroin overdose?

A

yes

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52
Q

Kidney functions:

A

Filter waste from bloodstream, electrolye balance, fluid balance, drug metabolism, toxin removal, drug metabolism, toxin removal , hormone secretion

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53
Q

Hormones secreted from the kidneys regulate:

A

BP, Ca+ metabolism, RBC production

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54
Q

Hormone released from kidneys that regulates BP:

A

Renin

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55
Q

Hormone released from the kidneys that controls Ca+ metabolism:

A

Calcitrol

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56
Q

Hormone secreted by kidney that control BC production:

A

erythropoietin

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57
Q

Risk factor and affect of kidney disease:

A

BP

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58
Q

Normal GFR:

A

> 9 ml/min/1.73 m^2

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59
Q

GFR of disease kidney:

A

< 60L:

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60
Q

GFR of kidney failure:

A

<15

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61
Q

Units for GFR:

A

volume/ min/ surface area

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62
Q

diseased state for kidney is what fraction of normal

A

2/3

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63
Q

BUN sf:

A

Blood urine nitrogen

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64
Q

Urea nitrogen comes from;

A

protein breakdown

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65
Q

Does BUN inc or dec as kidney function decreases?

A

increases

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66
Q

Normal BUN:

A

7-20 mg/dll

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67
Q

Waste product of muscle metabolism:

A

serum creatinine

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68
Q

How do serum creatinine levels vary?

A

race, age, body mass

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69
Q

Normal serum creatinine:

A

0.6-1,2 mg/dl

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70
Q

TF? Serum creatinine levels are lower in females.

A

T

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71
Q

Serum creatinine level that indicates end stage disease:

A

> 10 mg/dl

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72
Q

Inc/ dec creatinine, dec kidney function:

A

inc

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73
Q

This ratio indicates level and location of dysfunction:

A

Bun: creatinine ratio

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74
Q

This tells you likely site of problem in kidney:

A

relative kidney function

75
Q

Bun:Cr >20:1 :

A

Prerenal issue, BUN reabsorption is increased. BUN is disproportionately elevated in relation to creatinine in serum

76
Q

BUN: CR ratio: 10-20:`1:

A

Normal to posternal issue, normal range, can also be postrenal disease, BUN reabsorption is w/in normal limits

77
Q

BUN: CR ratio: <10:1

A

Intrarenal, Renal damage, renal damage causes reduced reabsorption of BUN, therefore lowering BUN:Cr ratio

78
Q

Urea:Cr 40-100:1:

A

Normal to posternal issue, normal range, can also be postrenal disease, BUN reabsorption is w/in normal limits

79
Q

Urea:Cr: >100:1:

A

Prerenal issue, BUN reabsorption is increased. BUN is disproportionately elevated in relation to creatinine in serum

80
Q

Urea <40:1:

A

Intrarenal, Renal damage, renal damage causes reduced reabsorption of BUN, therefore lowering BUN:Cr ratio

81
Q

TF? You want GFR and BUN to be high and creatinine to be low.

A

F. GFR high, BUN and Creatinine to be low

82
Q

Other tests of renal function:

A

`ultrasound, CT, biopsy, urinalysis, creatinine clearance

83
Q

CT can be used for this in renal failure:

A

postrenal obstruction, tumors, masses

84
Q

Creatinine clearance:

A

urodynamic test, sequential series of lab tests to see actual clearance of creatinine over time

85
Q

Sequelae of end stage renal disease:

A

Uremea, fluid overload/TN, CV disease, azotemia

86
Q

What is azotemia:

A

nitrogen in bloodstream-metabolic acidosis (electrolyte imbalance)

87
Q

What is uremea:

A

excess urea and creatinine in blood

88
Q

Symptoms of azotemia:

A

hyperventilation, fatigue, nausea, diminished reserve, hematologic problems, renal osteodystrophy, neurologic involvement, uremic stomatitis (aspirin burn-like)

89
Q

What causes hyperventilation in end stage renal disease:

A

Pulmonary system trying to compensate for renal system

90
Q

Hematologic problems related to end stage renal disease

A

anemia, WBC dysfunction, coagulopathy

91
Q

Renal osteodystrophy:

A

skeletal malformations, hormone involved in bone remodeling secondary hyperparathyroidism osteomalacia, osteofibrosis, osteosclerosis, bone metabolism is affected

92
Q

Neurologic involvement related to end stage renal disease:

A

depression, psychosis, convulsive disorders - body overwhelmed by toxins

93
Q

Uremic stomatitis:

A

uncommon, may be accompanied by burning and taste alterations, assoc w inc ammonia compounds in saliva

94
Q

Tx for end stage renal disease:

A

hemodialysis, periotoneal (another part of your body)dialysis, transplant

95
Q

THere are __X as many ppl on hemodialysis than transplant recipients:

A

2

96
Q

When to schedule appts for pts on hemodialysis:

A

either MWF or T TH S

97
Q

Why is vascular surgery done for any pt on dialysis?

A

in order to speed flow of venous flow, artery connected to vein

98
Q

Hemodialysis is:

A

AV fistula-surgical anastomsis of artery and vein, bypassing capillaries

99
Q

Wks it takes for hemodialyis to mature:

A

4-6wks

100
Q

How many needles are inserted during dialysis?

A

2 needles

101
Q

What is prone to infection in pts on hemodialysis?

A

AV fistula

102
Q

Drug used during dialysis:

A

Heparin, to prevent clotting

103
Q

How many hours after dialysis do we have to wait before we treat at UB?

A

We don’t treat the same day as dialysis

104
Q

Peritoneal dialysis:

A

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
Q

Is the risk of infection higher or lower for peritoneal dialysis compared to hemodialysis?

A

lower

106
Q

Type of machine used or peritoneal dialysis:

A

none

107
Q

Most common type of peritoneal dialysis:

A

continuous ambulatory peritoneal dialysis (CAPD)

108
Q

Time per day CAPD is done:

A

4

109
Q

continuous peritoneal dialysis, machine or no machine?

A

machine

110
Q

When is continuous peritoneal dialysis typically performed?

A

while sleeping

111
Q

TF? Some forms of intermittent peritoneal dialysis are done while sleeping.

A

T

112
Q

Typical site for peritoneal dialysis catheter:

A

stomach

113
Q

Advantages of peritoneal dialysis:

A

can be done at home, easy to learn/ travel with, fluid balance is easier than hemodialysis

114
Q

1st choice tx of kidney failure if transplant is not available:

A

peritoneal dialysis

115
Q

Disadv, peritoneal dialysis:

A

requires attention to cleanliness while performing, infection, addition of fluid too quickly (leaks into surrounding tissue, hernias due to abdominal fluid load)

116
Q

Possible consequences of addition of fluid too quickly in peritoneal dialysis:

A

fluid leaks into surrounding tissue, hernias due to abdominal fluid load

117
Q

More expensive, peritoneal dialsis or hemodialysis in end stage renal disease?

A

hemodialysis

118
Q

How many tmes more likely are hemodialysis pts likely to be hospitalized?

A

2 X

119
Q

Less sick ppl, hemodialysis or peritoneal dialysis?

A

peritoneal

120
Q

What should be screened for with pts with renal failure/ dialysis?

A

bleeding disorders (platelet count and function, Hb, Hct)

121
Q

Blood screening tests to get for pts with renal failure/ dialysis:

A

platelet count, Hb, Hct

122
Q

Why ppl have bleeding disorders:

A

erythropoietin stim hormone dec (lower red count, likely to bleed bc of platelet fxn, dialysis reduces platelet fxn,)

123
Q

Main determinant of uremic bleeding in end stage renal disease and dialysis:

A

platelet function

124
Q

Is platelet count normally low or high in end stage renal disease?

A

low

125
Q

What causes decreased platelet function in end stage renal disease:

A

dec platelet aggregation, impaired platelet adhesiveness

126
Q

Dec platelet function leads to:

A

dec platelet glycoproteins, uremic toxins, anemia

127
Q

Platelets adhere to these at the endothelial cell surface;

A

subendothelial collagen receptors exposed at injury site

128
Q

Cx man of impaired platelet function in end stage renal disease:

A

bruising, prolonged bleeding in response to injury , gingival bleeding and epitaxis possible but not common, inc sensitivity to aspirin

129
Q

word for bleeding from the nose:

A

epitaxis

130
Q

Questions to ask f a person starts bleeding from their nose at dental appt:

A

Hypervascualr septum? on dialysis? spontaneous bleeding?

131
Q

Why is anemia common in end stage renal disease?

A

due to dec erythropoetin production

132
Q

How to improve platelet function in end stage renal disease:

A

correction of anemia:

133
Q

How to correct anemia in end stage renal disease:

A

transfusions, Erythropoetin stimulating agent (common for dialysis pts)

134
Q

Where to take BP for pts on dialysis:

A

side opposite the port/ shunt

135
Q

How to manage infections in the oc for pts with renal failure/ dialysis:

A

aggreessively

136
Q

Avoid these drugs for pts w renal failure/ dialysis:

A

nephrotoxic drugs

137
Q

How might prescribing be different for pts w renal failure/ dialysis?

A

adjust dosages or inc intervals

138
Q

Drugs to avoid for pts with renal failure/ dialysis (RF/D):

A

ASA, acyclovir, NSAIDs, ketoconazole (antifungal)

139
Q

Inc dose intervals of these drugs for pts with RF/ D:

A

penicillins, cephalosporins, tetracyclin

140
Q

Can penicillins, cephalosporins, or tetracyclins be metabolized by pts with RF/ D?

A

yes, but more slowly

141
Q

Drugs that are ok to use for pts with RF/ D:

A

narcotics, erythromycins, acetominophen

142
Q

Can narcotics be used for pregnant women?

A

yes

143
Q

TF? acetaminophenis hepatotoxic.

A

T. pts can burn liver if taking in excess

144
Q

Why to treat pts on non-dialysis days:

A

bc of anticoagulation during dialysis

145
Q

Drug used during dialysis;

A

heparin

146
Q

1/2 life of heparin:

A

2-4hr

147
Q

TF? You should consider antibiotic prophylaxis for pts on hemodialysis.

A

T, less common lately, consult physician

148
Q

Benefit of antibiotics for pts on hemodialysis:

A

dec rate of bacteremia, dec need for catheter removal 2’ to complications, may lead to antimicrobial resistnace

149
Q

Wy do pts on hemodialysis need prophylaxis for dental procedures?

A

bc of the presence of an arteriovenous shunt for dialysis, shunt infection, risk of infective endocarditis

150
Q

% of AV shunts that become infected:

A

22% (3.2/100 pts-mo)

151
Q

Complications of AV shunt infection;

A

IE and death

152
Q

% of cases of AV shunt infection that require heart valve replacement:

A

25%

153
Q

% of normal GFR that indicates need for renal transplant;

A

<20 % normal

154
Q

Contraindications for renal transplants:

A

cardiac and pulmonary insufficiency, liver failure, Hep C, HIV, active cancer, noncompliance

155
Q

Most common cause of renal transplant:

A

Dm

156
Q

Are most pts on dialysis prior to transplant?

A

yes

157
Q

Pts are typically in one of these 2 stages of renal disease before being put on dialysis:

A

4 or 5

158
Q

% of kidney donors that re living donors in the US:

A

50%

159
Q

TF? A very close MHC match is very critical for kidney transplant pts;

A

F. Not anymore, better anti-rejection drugs

160
Q

What happens to the failed kidney when a pt needs a transplant?

A

left in place, donor kidney placed in lower abdomen

161
Q

Avg life span of donor kidney:

A

10-15y (he said yr)

162
Q

Acute kidney rejection occurs in what % of pts w/in how many days of the transplant?

A

10-25%, w/in 60d

163
Q

How long does a pt ith a kidney transplant have to stay on immunosuppressive drugs?

A

forever

164
Q

Immunosuppressive drugs used after kidney transplant:

A

mycophenolate, prednisone, cyclosporin, tacrolimus

165
Q

Mycophenolate is aka:

A

CellCept

166
Q

Pts taking CellCept are also taking:

A

cyclosporin and corticosteroids

167
Q

Adverse affects of Mycophenolate (CellCept):

A

abdominal pain, anemia, diarrhea, fever, HTN, infection, pharyngitis, resp tract infection, sepsis, oportunisticinfection

168
Q

What is cyclosporin:

A

immunosuppressive drug w potent effects on response of T-lymphocytes and cell-mediated immunity

169
Q

Uses of cyclosporin:

A

rejection of transplants, psoriasis, RA

170
Q

Adverse effects of cyclosporin:

A

candidiasis, *gingival overgrowth, tremors, headache, HTN, Hepatotoxicity, nephrotoxicity

171
Q

Precautions to take for pts taking cyclosporin:

A

momnitor vital signs, place on freq recall

172
Q

Symptoms pts that are taking cyclosporin may have:

A

dyscrasias - infection, bleeding, and poor healing

173
Q

Should prophylactic antibiotics be given to pts taking cyclosporin?

A

usually recommended for pts wth organ transplant and immunosuppression, request consult for blood studies and baseline Bp

174
Q

Tests to request for pt w organ transplant and immunosuppression:

A

blood studies, baseline BP

175
Q

Precautions for prednisone:

A

pregnancy category C, diabetes, glaucoma, osteopoosis, seizure disorders, ulcerative colitis, HF, myasthenia gravis, renal disease, esophagitits, peptic ulcer, rifampin, drug interactions

176
Q

Dental considerations for pts taking prednisone:

A

monitor vital signs, avoid aspirin, blood dyscrasias, symptoms of oral infection may be masked, freq recall visits

177
Q

Pts that may require supplemental sterois for dental treatment:

A

pts who have been or are currently on chronic steroid therapy greater than 2 wks

178
Q

This can lead to adrenal insufficiency:

A

heavy hitting immunosuppressant

179
Q

Adverse effects of prednisone:

A

candidiasis, dry mouth, oor wound healing, petechiae, depression, mood changes, GI hemorrhage, pancreatitis, increased appetite, thrombocytopenia, fungal infections, osteoporosis

180
Q

Common location for petechiae hemorrhaging in pts taking prednisone:

A

buccal mucosa

181
Q

An edentulous pt taking prednisone can generate enough force to:

A

cause bleeding of the ridges

182
Q

Should we consider propylactic antibody tx for pts who have had a kidney transplant?

A

yes

183
Q

How to treat infections for pts with kidney transplant:

A

aggressively

184
Q

Big side effect of immunosuppressants taken for rental transplants:

A

adrenal suppression w steroids

Evaluating the Medically Complex Patient (4 decks)

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