Kidney and CT (Deluke) Flashcards
Is kidney disease sudden or progressive?
Progressive
What is the term for when kidney function can no longer sustain life (10% or less of normal kidney function)?
End stage renal disease (ESRD)
What are 8 causes of renal failure?
- Diabetic nephropathy
- Nephrosclerosis caused by chronic HTN
- Idiopathic glomerulonephritis
- Autoimmune disease (SLE)
- Drug-induced nephropathy
- Congenital kidney abnormalities
- Infections
- Stones
What are 3 treatment options for ESRD?
- Hemodialysis (HD)
- Continuous ambulatory peritoneal dialysis (CAPD)
- Transplant
What is a concern for dialysis patients as far as their AV fistula shunt?
Must be protected, don’t take BP on that side
Which dialysis patient presents with no particular difficulties for dental care: hemodialysis or Chronic Ambulatory Peritoneal Dialysis (CAPD)?
CAPD
ESRD patient cannot filter phosphate (hyperphosphatemia) which means they cannot absorb calcium (hypocalcemia) which causes what hormonal change?
Elevated PTH to mobilize calcium out of bone into soft tissue causing secondary hyperparathyroidism or Renal Osteodystrophy (renal rickets)
What system is interrupted in ESRD patient leading to HTN?
Renin-angiotensin system
The secondary hyperparathyroidism due to ESRD can manifest how in dental radiographs?
- Central giant cell lesions (punched out multilocular radiolucencies)
- Brown tumors
- Loss of lamina dura
- “Ground glass” alveolar bone
What causes the bone pathology in ESRD?
Calcium being mobilized from bone
Is antibiotic prophylaxis required on a hemodialysis patient?
Maybe to prevent bacteremia at shunt, but consult MD
What screening labs might be indicated for a hemodialysis patient before surgical procedures?
- CBC
- PT
- PTT
- Electrolytes
If a ESRD patient is taking cyclosporine what antibiotic is contraindicated?
Erythromycin because it inhibits cyclosporine metabolism causing toxicity
What antibiotic is contraindicated in Chronic Renal insufficiency (CRI) patient?
Tetracycline because it increases catabolism and can exacerbate renal impairment
What renal patient can be given NSAIDS: ESRD or CRI?
ESRD
Can Meperidine (Demerol) be given to ESRD/CRI patient for analgesia?
No, becomes normeperidin, accumulates and causes seizures
A patient with marked flattening of condyles, and subsequent anterior open bite with no previous history may have what autoimmune disorder?
Rheumatoid arthritis
What will a rheumatoid arthritis patient with an artificial joint require before dental treatment that will cause bleeding?
Prophylactic antibiotic
What patients with prosthetic joint replacements will need prophylactic antibiotics?
- Drug-induced immunosuppression (steroids, methotrexate, immurna, cyclosporine, cytoxin), on chemotherapy
- Type I diabetic
- History of joint infection or trauma, or
- HIV patients
- Any patient with multiple comorbidities or multiple medical problems, what will they require?
How will a rheumatoid arthritis joint feel versus a degenerative joint disorder joint feel?
Rheumatoid arthritis is softer, DJD will be bony hard
What is a difference in the presentation of degenerative joint disorder in the TMJ versus Rheumatoid arthritis in the TMJ?
DJD is usually unilateral
What is an important screening test for systemic lupus erythematosus (SLE) and other autoimmune disorders?
Antinuclear antibody (will be positive if you have the autoimmune disorder)
What is a consideration for an SLE patient?
Immunosuppressed with steroids or cytotoxins
May be anemic or thrombocytopenic or have leukopenia
What is a facial and oral sign indicative of SLE?
- Butterfly rash on cheeks
- Discoid lesions on palate
- Desquamative gingivitis
- Lichenoid patterns
What is the ideal CD4 count for the treatment of an HIV positive patient?
400 or more
Can an HIV positive patient be treated if CD4 300 or greater?
Yes
What is an HIV positive CD4 count that indicates a significantly increased risk of infection or problems with healing?
Under 200
What is an important part of treatment for organ transplant patient Pre-transplant?
Eliminate dental infection and potential for future infection, e.g. may treat a bit more aggressively with end in mind
3 months after an organ transplant, should elective dental treatment be performed?
No
If patient is stable in the 3-6 month range post- transplant, can they get elective dental treatment?
Yes with a medical consult
When is elective dentistry alright post-transplant?
6 months if stable, still get consult
What antibiotic is often indicated for post-transplant prophylaxis?
Broad spectrum
- Amoxicillin, 2g, 1 hr prior AND Metronidazole 500mg, 1 hr prior
- Vancomycin 1g, IV 1 hr prior if penicillin allergy
What antibiotic should be avoided in transplant patients and why?
Erythromycin. Patient will be drug-induced immunosuppressed, and if via cyclosporine, erythromycin will have an adverse drug reaction
Should surgery be performed on a dialysis patient the same day as their dialysis treatment?
No. Should be done on the “off” day.
What is the critical value for platelets for an extraction?
About 75,000
Why must a patient not be treated in surgery the day of dialysis?
- On anticoagulation therapy because of dialysis
2. If done right before dialysis, system not in an ideal state because they have more “bad” stuff in their system
What are complications of ESRD?
- Hyperkalemia
- Anemia
- Bleeding
- Hypertension
- Immune compromise
- Elevated risk of exposure to Hep B, Hep C and HIV
Is oral penicillin indicated in a patient with ESRD/CRI?
Short course is okay.
Can acetaminophen be tolerated in a patient with renal disease?
Yes but avoid chronic high doses
Is Demerol contraindicated in renal disease patients?
Yes. It is metabolized to normeperidine which accumulates in renal failure and can cause seizures
What are three connective tissue disorders?
- Rheumatoid Arthritis (RA)
- Degenerative Joint Disease (DJD)
- Systemic Lupus Erythematosus (SLE)
What are some potential complications of rheumatoid arthritis?
- Pericarditis
- Pulmonary fibrosis
- Amyloidosis
- Anemia
- Thrombocytopenia
- Neutropenia
Is TMJ involvement common in RA patients?
Yes. Usually bilateral.
Will RA patients be slow healers?
Yes
What involves larger weight-bearing joints and also hands: RA or DJD?
DJD
What unilaterally involves the TMJ: RA or DJD?
DJD
What additional radiographic findings will you see in the TMJ of a DJD patient?
- Pseudocyst
2. Spur(s)
What clinical sign will you see with DJD?
Crepitus
Is SLE more common in males or females?
Females
In CAPD, is the solution instilled into the peritoneum hypertonic or hypotonic?
Hypertonic
What does EPO do?
Increases the O2 carrying capacity of red blood cells
What are additional lab findings in renal disease?
- Elevated blood urea nitrogen (BUN), creatinine
- Proteinuria
- Abnormal platelets
Which category of antibiotics will tend to exhibit the greatest percentage of drug-drug interactions?
Macrolides (erythromycin, clarithromycin, and azithromycin) via cytochrome 450
Can ASA and NSAIDS be used in patients with ESRD/CRI?
Yes but only in a short course and use caution due to the anti-platelet effect
What is the term for an abnormal layer of fibrovascular tissue or granulation tissue found on a joint in a patient with rheumatoid arthritis?
Pannus
What is the term for hard or bony swellings that can develop in the distal interphalangeal joints (DIP) (the joints closest to the end of the fingers and toes) and are a sign of osteoarthritis or DJD?
Heberden’s Nodes
Which joint disorder has a pathophysiology that involved trauma or normal wear and tear?
DJD or Osteoarthritis (RA is autoimmune)
How is DJD treated?
Usually anti-inflammatory meds or surgery for more advanced cases
What are some examples of patients who are immunosuppressed?
- Renal dialysis patients
2 .Patients on high dose or long-term steroids - Immunosuppressive drugs (many drugs for RA, SLE or other auto-immune disorders)
- Chemotherapy
- HIV infection
- Pre / Post organ transplant patient
- Diabetics
What is the goal when treating a pre op organ transplant patient?
Eliminate infection and the potential for future infection
Will a pre op organ transplant patient need to be more aggressively treated?
Yes. For example, you should extract “borderline” teeth.
What should be emphasized in a pre op organ transplant patient?
Continuing recalls after the transplant
Pre op organ transplant guidelines apply especially to what organs?
Kidney, Heart and Liver
Should you perform elective treatment on a patient within the first 3 months after an organ transplant?
No
With regards to treatment, what should you do with a patient who had an organ transplant 3-6 months ago and is currently in stable condition?
It depends on how well the healing process has progressed. Get a medical consult to confirm their status.
At what point is it okay to perform elective dentistry in a patient who has received an organ tranplant?
After 6 months but it is still best to obtain a med consult
What should you do if a post op organ transplant recipient is showing signs of chronic rejection?
Medical consult
Why should erythromycin be avoided in organ transplant recipients?
It is hepatoxic and may interact with cyclosporine, which many transplant patients will be taking
