HD 2 - Renal disorders and dentistry Flashcards
When is the best time to treat a dialysis patient on heparin?
One day after dialysis, as heparin will have worn off but dialysis will have peaked
What is nephrotic syndrome?
Too much protein excreted in the urine
What are the early signs of chronic kidney disease?
Nocturia (peeing at night) and poor appetite
What are the late signs of chronic kidney disease?
Hypertension and uraemia
How is oedema formed from in nephrotic?
Protein loss, less protein in IV compartment, no oncotic pressure, leaks out and forms oedema
What are the effects of chronic renal failure patients being on long term steroid treatments and electrolyte disturbances?
Increased infection risk
Increased risk of CV disorders - increased atherosclerosis
When would bilateral periorbital oedema be unusal?
Anything other than nephrotic syndrome
What is the survival 1 year after renal transplant?
90%
What oral infections can occur on steroid treatment after renal transplant?
Oral candidosis, herpes simplex, zoster virus infections
After a renal transplant what prophylaxis is given to prevent viral infection?
Low dose aciclovir
What are the oral manifestations indicating diabetes?
PD with good OH
Define renal osteodystrophy?
Wasting away of bone due to kidney disease
How does renal osteodystrophy occur?
Increased plasma phosphate levels
Leading to suppressed plasma Ca and increased PTH
Ca metabolism is further compromised by vitamin D metabolism disruption
Failure of 25-HCC –> 1,25-HCC, causing secondary hyperPT
Increased PT causing Ca to be taken out of the bones
How does anaemia occur in chronic renal failure?
EPO production failed from kidneys
Renal loss of RBCs, marrow fibrosis and increased RBC fragility, therefore early destruction (+possible bleeding disorders)
Marrow fibrosis may lead to decreased platelet count and poor platelet function
How is an aterio-venous fistula formed? (NEVER USED BY DENTIST)
Surgically at antecubital fossa or wrist, causing high blood flow and easy vascular access
How is haemostasis disrupted in an impaired chronic kidney disease patient?
CKD causes impaired platelet adhesion, decreased vWF, decreased thromboxane, increased prostacyclin levels (vasodilation), therefore herparinisation used
What does an examination of a steroid patient present with?
Oedema Moon face Pulmonary/cardiac effusions Osteodystrophy Oral ulceration Increased infection Gingival hyperplasia with cyclosporin BEWARE of skin cancers
What does an examination of a dialysis patient present with?
Neoplastic/infective swelling of major SGs, esp. parotid = Sialosis
Palatal and buccal keratosis sometime seen as white mass
In kids: decreased growth, delayed tooth eruption and enamel hyperplasia
Post extraction why are chronic kidney disease patients asked not to swallow blood?
Stops renal function
Why is gentamicin avoided in renal disease?
It is nephrotoxic
Why is erythromycin contraindicated in transplant patients?
Patients are taking ciclosporin and can reach toxic levels
In renal disease what drugs can still be prescribed but need reduced dosages?
Aciclovir, amoxicillin, ampicillin, cefalexin and erythromycin
What is the only tetracycline that doesn’t need to be avoided?
Doxycline
What occurs in acute renal failure? And how is it treated?
Medical emergency
Seen in hypovolaemia (decreased urine output)
Potassium levels rise to dangerous levels and need lowered
Lower levels with:
o Calcium resonium = paste given rectally
o Glucose and insulin infusions IV – both take K out of bloodstream
Monitor urine levels
May progress to dialysis
What heart problem can be predisposed with electrolyte disturbances?
Cardiac arrhythmias
