Nephrology Flashcards
1
Q
Chronic Renal Disease
A
- F > M
- more likely to progress to renal failure in men
- 35% of adult diabetics
- 20% of adults with hypertension
- usually irreversible and progressive end-stage renal disease
2
Q
Clinical Symptoms of Chronic Renal Disease
A
- initially asymptomatic until GFR < 25%
- uremia
- thrombocytopenia–>purpura
- diminished thromboxane–>impaired thrombin formation
- elevated prostacyclin–>poor platelet aggregation
- defective von Willebrand factor
- hypertension
- anemia
- defective phagocyte function–>infection
- renal osteodystrophy
3
Q
Renal Osteodystrophy
A
- phosphate retention
- calcium excretion
- increased PTH (secondary hyperparathyroidism)
- giant cell lesions of the bone
4
Q
Management of Chronic Renal Disease
A
- control blood pressure
- treat infection
- restrict potassium
- CV risk-reduction strategies
- replenish iron stores
- inhibit bone resorption
* *reduce PTH/bisphosphonates - avoid renally-cleared/nephrotic drugs
5
Q
Dental Aspects-Hemodialysis
A
- periodontal disease is COMMON
- dental tx best done the day AFTER dialysis
- bleeding tendency due to heparinization
- oral infection–>septicemia
- hyposalivation
- mucosal ulceration
- NO general anesthesia
- uremic stomatitis, metallic taste, loss of lamina dura, osteoporosis, giant cell lesions of bone
6
Q
Uremic Stomatitis
A
- patient’s breath may smell like ammonia
2. white lesions
7
Q
Nephrotic Syndrome
A
- glomerular damage–>proteinuria–>hypoalbuminemia–>edema
- face, genital, lower limb edema
- ascites
- loss of immunoglobuilns–>infection
- increased clotting factors–>hypercoagulability
- Vitamin D deficiency–>renal osteodystrophy
8
Q
Management of Nephrotic Syndrome
A
- reduce proteinuria
- control infections
- prevent thromboembolism
- corticosteroids, low salt/high protein diet, Warfarin, prophylactic antimicobials
9
Q
Nephrotic Syndrome-Dental Aspects
A
- long-term corticosteroid side effects
2. consider antibiotic prophylaxis
10
Q
Nephrolithiasis (Kidney Stones)
A
- VERY common
- usually visible radiographically
- no consistent relationship to underlying systemic disease
- no relationship to dental calculus or salivary stones
- if not spontaneously passed, treated with lithotripsy or surgical removal
11
Q
Renal Cancer
A
- 90% are adenocarinomas (malignancy of glandular tissue)
- hematuria is often the initial symptom
- treated with nephrectomy
- may metastasize to the jaws
12
Q
Renal Transplantation
A
- treatment of choice for ESRD
- 90% one-year graft survival
- 70% five-year graft survival
- life-long immunosuppresion (increased oral infection risk, gingival hyperplasia, oral ulceration)
13
Q
Cyclosporine and Nifedipine
A
- sometimes given to patients to help with immunosuppression after a kidney transplant
- may lead to gingival hyperplasia
- improved oral hygiene can help offset the gingival hyperplasia
14
Q
Acute Renal Failure
A
- Pre-renal factors (55%)
* *hypotension
* *thrombosis
* *sepsis
* *dehydration
* *heat stroke
* *drugs - Post-renal factors
* *obstructed urine flow
15
Q
Chronic Renal Disease - Anatomical Classification
A
- vascular
- glomerular
- tubulointerstitial
- obstructive
16
Q
Chronic Renal Disease - Etiology
A
- diabetes
- hypertension
- glomerulonephritis
17
Q
Females/men are more likely to get chronic renal disease
A
Females
