HD 2 - Renal disorders and dentistry

Question 1

When is the best time to treat a dialysis patient on heparin?

Answer 1

One day after dialysis, as heparin will have worn off but dialysis will have peaked

Question 2

What is nephrotic syndrome?

Answer 2

Too much protein excreted in the urine

Question 3

What are the early signs of chronic kidney disease?

Answer 3

Nocturia (peeing at night) and poor appetite

Question 4

What are the late signs of chronic kidney disease?

Answer 4

Hypertension and uraemia

Question 5

How is oedema formed from in nephrotic?

Answer 5

Protein loss, less protein in IV compartment, no oncotic pressure, leaks out and forms oedema

Question 6

What are the effects of chronic renal failure patients being on long term steroid treatments and electrolyte disturbances?

Answer 6

Increased infection risk

Increased risk of CV disorders - increased atherosclerosis

Question 7

When would bilateral periorbital oedema be unusal?

Answer 7

Anything other than nephrotic syndrome

Question 8

What is the survival 1 year after renal transplant?

Answer 8

90%

Question 9

What oral infections can occur on steroid treatment after renal transplant?

Answer 9

Oral candidosis, herpes simplex, zoster virus infections

Question 10

After a renal transplant what prophylaxis is given to prevent viral infection?

Answer 10

Low dose aciclovir

Question 11

What are the oral manifestations indicating diabetes?

Answer 11

PD with good OH

Question 12

Define renal osteodystrophy?

Answer 12

Wasting away of bone due to kidney disease

Question 13

How does renal osteodystrophy occur?

Answer 13

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

Question 14

How does anaemia occur in chronic renal failure?

Answer 14

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

Question 15

How is an aterio-venous fistula formed? (NEVER USED BY DENTIST)

Answer 15

Surgically at antecubital fossa or wrist, causing high blood flow and easy vascular access

Question 16

How is haemostasis disrupted in an impaired chronic kidney disease patient?

Answer 16

CKD causes impaired platelet adhesion, decreased vWF, decreased thromboxane, increased prostacyclin levels (vasodilation), therefore herparinisation used

Question 17

What does an examination of a steroid patient present with?

Answer 17

Oedema 
Moon face 
Pulmonary/cardiac effusions 
Osteodystrophy 
Oral ulceration 
Increased infection 
Gingival hyperplasia with cyclosporin 
BEWARE of skin cancers

Question 18

What does an examination of a dialysis patient present with?

Answer 18

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

Question 19

Post extraction why are chronic kidney disease patients asked not to swallow blood?

Answer 19

Stops renal function

Question 20

Why is gentamicin avoided in renal disease?

Answer 20

It is nephrotoxic

Question 21

Why is erythromycin contraindicated in transplant patients?

Answer 21

Patients are taking ciclosporin and can reach toxic levels

Question 22

In renal disease what drugs can still be prescribed but need reduced dosages?

Answer 22

Aciclovir, amoxicillin, ampicillin, cefalexin and erythromycin

Question 23

What is the only tetracycline that doesn’t need to be avoided?

Answer 23

Doxycline

Question 24

What occurs in acute renal failure? And how is it treated?

Answer 24

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

Question 25

What heart problem can be predisposed with electrolyte disturbances?

Answer 25

Cardiac arrhythmias