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Dental Mgmt of Medically Compromised Pts > Kidney disease > Flashcards

Kidney disease Flashcards

1
Q

Which portion of the kidney is highly vascular and where most of the filtration and reabsorbtion of nutrients occurs?

A

Renal cortex

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2
Q

Which portion of the kidney houses the nephrons?

A

Renal pyramid/medulla

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3
Q

____% of renal plasma flow is filtered into Bowman’s space

A

20%

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4
Q

___ is portion of kidney where blood contents first get put into the collecting system

A

Glomerulus

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5
Q

The _________ gradient forces glomerular filtration.

A

hydrostatic pressure

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6
Q

What are the 3 autoregulation factors of GFR?

A
  1. vasoreactive (myogenic) reflex of afferent arteriole
  2. tubuloglomerular feedback (TGF)
  3. angiotensin II-mediated vasoconstriction of the efferent arteriole
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7
Q

(autoregulation factors of GFR)

  • causes dilatation or constriction of the afferent arteriole to maintain
    stable glomerular pressure in response to variations in systole
A

vasoreactive (myogenic) reflex of afferent arteriole

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8
Q

(autoregulation factors of GFR)

  • causes dilatation or constriction of the afferent arteriole to maintain
    stable glomerular pressure in response to solute concentration changes
    detected by the macula densa cells in the distal/ascending Loop of
    Henle
A

tubuloglomerular feedback (TGF)

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9
Q

Where does the angiotensin 2-mediated vasoconstriction occur?

A

Efferent arteriole

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10
Q 
\_\_\_\_ function
• Water regulation 
• Electrolyte regulation
• Extracellular volume/pressure regulation
• Acid-base homeostasis
• Endocrine/metabolic 
oKinins
oErythropoietin 
oPhosphate 
oVitamin D 
oRenin  
• Blood plasma filtration
oGlucose and amino acid reabsorption
oCalcium and phosphate regulation 
• Excretion of metabolic waste
–nitrogenous, etc.
• Urine production 
• Prostaglandin production
A

Kidney function

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11
Q

A condition in which the kidneys suddenly can’t filter waste from the blood.
Acute renal failure develops rapidly over a few hours or days. It may be fatal. It’s most
common in those who are critically ill and already hospitalized.

A

Acute renal failure

Acute Kidney injury

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12
Q 
Symptoms
decreased urinary output
swelling due to fluid retention
nausea
Fatigue
shortness of breath. 
Sometimes symptoms may be subtle or may not 
appear at all.
A

Acute renal failure

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13
Q

What are the 3 causes of acute renal failure

A
  1. Pre-renal
  2. Intrinsic Renal
  3. Post-renal
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14
Q

Which cause of acute renal failure?

  • low blood flow leading to low CO and bp
  • Kidney tries to compensate
A

Prerenal ARF

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15
Q

Which cause of acute renal failure?

  • Glomerular
  • Vascular
  • Ischemia
  • Sepsis/infection
  • Nephrotoxins
A

INtrinsic

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16
Q

These drugs are toxic to kidney in improper doses/condtions and cause ______
ACE-I: monopril, captopril, enalapril
ARB: angiotensin receptor blocker, (Diovan, Cozaar,
Benicar);
NSAIDs:Indomethacin
PPI: proton pump inhibitors Prilosec, Prevacid &
Nexium (also linked to stomach cancer)
TTP-HUS, thrombotic thrombocytopenic purpura–
hemolytic-uremic syndrome.

A

ARF

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17
Q

Which cause of acute renal failure?

-back up from bladder/ bladder obstruction

A

Postrenal

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18
Q

How do you treat ARF?

A

Address cause
Fluids
Meds
Dialysis

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19
Q 
The following cause \_\_\_\_\_\_:
•Chronic Glomerulonephritis 
•Systemic Lupus Erythematosus
•Neoplasms
•Polycystic kidney disease 
•AIDS nephropathy 
•Diabetic nephropathy
A

Chronic kidney failure

20
Q

The following are risk factors for ____:

A 
Age (≥60 years of age) 
Smoking
Obesity 
HTN :affects endothelial cells
• poorly controlled
Diabetes 
• 40-50% of patients with type 2 DM will 
develop CKD
Nephrotoxins/Drugs
Infections 
Low birthweight
Chronic Inflammation
21
Q

What is the value of GFR indicative of chronic kidney disease?

A

<60 ml/min/1.73^2

22
Q

What is the value of GFR for end stage renal disease?

A

<15 ml/min/1.73^2

23
Q

GFR steadily ______ with age

A

decreases

24
Q

How does bone metabolism change in chronic kidney disease?

A

Overall causes bone loss

25
Q 
Oral manifestations of \_\_\_\_\_\_\_;
Xerostomia/dry mouth
Halitosis
Dysgeusia 
• Metallic taste
Infections 
• Opportunistic 
• Periodontal
• Odontogenic
• Salivary 
Enamel defects 
• Children
A

Chronic kidney disease

26
Q
  • Lack of hydroxylation of 25(OH)D to 1,25(OH)2D which takes place in the kidneys
  • Causes lack of Ca+ absorption from intestines
  • Stimulates parathormone secretion and Ca+ loss from bone
  • Inhibits bone mineralization
A

Osteodystrophy

27
Q 
\_\_\_\_\_\_\_\_\_ Causes 
• Loss of lamina dura
• Demineralization (“ground-glass”)
• Expansile radiolucencies (CGCG, brown tumor) 
• Wide trabeculae
• Loss of cortication
• Sclerosis
A

Osteodystrophy

28
Q

What is the radiographic bone presentation seen in renal osteodystrophy

A

Ground glass trabeculation

29
Q

how are ca and vit d affected in renal osteodystrophy?

A

Both decreased; Vit D primary issue starting downstream cascade

30
Q

When should the dental appt be scheduled for pts on dialysis?

A

Day after dialysis

31
Q 
\_\_\_\_\_\_ (venous access)
• Arteriovenous fistula
• Ateriovenous graft
• Central venous catheter (special, short-term) 
• Machine filters blood
• Heparin is typically used 
• Every 2-3 days; 3-4 hours/session
• Risk of infectious disease –Hep B; Hep C
A

Hemodialysis

32
Q

How often is dialysis given?

A

Every 2-3 days

33
Q

Where are the AV fistulas and grafts placed for dialysis?

A

Usually in arm; chest is another location; peritoneum is also used

34
Q

What is necessary for kidney transplants?

A

ABO matching

HLA matching

35
Q

For a kidney transplant pt, how is their immunesystem?

A

Immunocompromised

36
Q

Kidney transplant meds for immunosuppression like cyclosporine can cause what 2 oral effects?

A
  • Gingival hyperplasia (cyclosporine)

* Aphthous-like ulcers (mTORi)

37
Q

What 2 vascular phenomena could occur in renal transplant pt?

A

Thrombosis and excessive bleeding

38
Q

Antibiotic prophylaxis IS NOT or IS routinely necessary for peritoneal dialysis

A

Is not

39
Q

Antibiotic prophylaxis may be necessary for patients with a _____ graft for dialsysis

A

synthetic AV

40
Q

If invasive procedures in patients with stage 4 (severe) or end-stage renal disease → what do you do for abx prophy?
Yes or no?

A

consult physician about need for antibiotics

41
Q

Antibiotic prophylaxis is necessary in hemodialysis patients if performing what procedure?

A

incision and

drainage

42
Q

What med can be given for pain in renal pts?

A

Tyelnol; reg doses over longer periods of time

43
Q

Can ASA be used in high or low doses for renal pts?

A

Low doses

44
Q

Are NSAIDs and Opioids good for renal pts?

A

Nope

45
Q

What are the 4 ABX that can be routinely used in rental pts wihtout adustment?

A

oClindamycin
oDoxycycline
oErythromycin
oMetronidazole

46
Q

Defer elective treatment within first _______ post-transplant

A

6 months

Dental Mgmt of Medically Compromised Pts (12 decks)

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