kidney II

Question 1

hemodialysis

Answer 1

3x a week

M/W/F
T/T/S

each treatment about 3-4 hours and usually about 3L is removed each session

HEPARIN IS USUALLY USED

Question 2

Peritoneal dialysis

Answer 2

at home

daily

10-24 hours (mostly overnight)

about 1.5 L of fluid is removed each treatment

heparin is usually not used

Question 3

access for hemodialysis

Answer 3

1. temporary catheter – internal jugular vein (high risk of infection )
2. permanent catheters - placed in internal jugualr or subclavian
3. primary AV fistula - foraem and hen upper arm - usually lower risk of infection
4. syntehtic AV graft – if pt. does not have adequate veins for access

Question 4

peritoneal dialysis

Answer 4

temporary/ permanent catheter is placed in abdominal cavity (periotoneal space)

Question 5

major cause of death in ESRD patients

Answer 5

cardiac related 50% of time

infections 15%

20% withdrawl from dialysis

Question 6

life span after dialysis

Answer 6

7-11 years if 40-44

4-5 years if 60-65

Question 7

patient survival post renal transplant

Answer 7

can be up to 91% with a living donor kidney

84% - non-extended criteria and recipient of deceased

70% - recipients of deceased and extended criteria

Question 8

bleeding with CKD?

Answer 8

yes - anemia –> but levels are normal bu the FUNCTION IS ABNORMAL - so longer bleeding time

*so normal platelet numbers, but defects in platelet aggregation and adhesion

Question 9

bleeding risk with anemia and precautions you should take

Answer 9

discontinue ASA 1 week prior to surgery and other antiplatalet drugs at least 72 hours before surgery

heparin free dialysis he day of or wait to perform surgery the next day

Question 10

dialysis can help treat uremic bleeding tendency?

Answer 10

True

Question 11

antibiotic prophylaxis for?

Answer 11

periotnela dialysis patients

2g amox 2 hour before

Question 12

oral manifestations of CKD

Answer 12

1. xerostomia
2. metalic taste – due to urea
3. uremic stomatitis - rare oral mucosa disorder assoicated with CKD
4. bone resorption and tooth mobility
5. higher degree of calculus, perio disease

Question 13

T/F periodontal disease is a modifiable risk factor for cardio disease in ESRD patients?

Answer 13

Looks like it because of the systemic inflammation associated

Question 14

which days are the longest gaps between treatment?

Answer 14

mondays and tuesdays depending on their 3 day schedule of MWF or TTS

Question 15

when to treat dialysis patients

Answer 15

day after is best

Question 16

narcotics and renal failure?

Answer 16

they can accumulate in renal failure so use sparingly and avoid Meperidine (seizures)

Question 17

dental managment of transplant patient

Answer 17

all transplant patients should undergo screening prior to transplant to assess periodontium and need for any extractions

care regarding bleeding, antibiotic prophylaxis, hypertension control and drug dosing is same as CKD patients

Question 18

indications for extraction in transplant patients

Answer 18

mobility greater than 5 or 6 and teeth with periapical lesions – or extensive caries or endo-perio problems

implants = postponed until health is stabilized

Question 19

dental care of transplant patients post transplant

Answer 19

all patients will be on immunosuppressants and must be continued throughout care

first 6 months – exam

over 6 months – safe to perform typical procedures