Renal Diseaseas Chronic Kidney Failure

Question 1

How many blood get filtered through kidney every day ?

Answer 1

180L
Each kidney has 3 million nephrons

Question 2

What causes kidney disease ? It give us a sign to ask those patient about there kidney condition ?

Answer 2

Diabetes mellitus
Chronic Hypertension
Glomeruloneohritis
Polycystic disease
Congenital

Question 3

What’s consequences of CKD what’s happen to their body ?

Answer 3

1.HTN
2.HYPERparathyrodism ( due to low calcium levels in blood )
3.Anemia ( no erythropoietin to produce RBC )
4.Immune dysfunction ( decrease immunoglobulins , decrease WBCs migration due to high urea levels in blood which is toxic to cells )
5. Platelets dysfunction ( also due to urea = bleeding )
6. Bone diseases (low ca , vit B )
7. Fluid overload
8. Electrolytic imbalance

Question 4

What’s about bleeding and immunity ?

Answer 4

Low immunity
High risk of bleeding

Question 5

What’s bone changes in jaw may be observed ?

Answer 5

Ostetitis fibrosa cystica(osteodystrophy) ( radiolucent circle , free of osteoblasts not mineralized circle ) .

Question 6

Does they develop candiasis ?

Answer 6

Yes

Question 7

What’s the first question ?

Answer 7

Which kidney disease does he has ?

Cause some only have an acute kidney injury or due to high muscles mass ( sport ) they have high creatinine .

Question 8

What’s the first question ?

Answer 8

Which kidney disease does he has ?

Cause some only have an acute kidney injury or due to high muscles mass ( sport ) they have high creatinine .

Question 9

Why we should ask about creatinine levels in first question and why ?

Answer 9

Creatinine is a chemical waste product of creatine. Creatine is a chemical made by the body and is used to supply energy mainly to muscles.

This test is done to see how well your kidneys work. Creatinine is removed from the body entirely by the kidneys. If kidney function is not normal, the creatinine level in your blood will increase. This is because less creatinine is excreted through your urine.

Question 10

Which individuals have high levels of creatitnine but they don’t have CKD ? Normal range 0.7-1.3mg/dl men
Women , 0.6-1.1mg/dl

Answer 10

Patients with 1 kidney (3-3.5) is good
Acute kidney injury
If it 1.3-1.6mg/dl then go normal it’s ok
In elders due to less nephrons
Athele individuals due to high muscles mass and take supplements

High amount of meat consuming

Question 11

In which creatinine and GFR levels you shouldn’t work and you must ask specialist ?

Answer 11

More than 2mg/dl
GFR >50 (always refer )
Refer

If it more than 4.5 it’s a problem

Question 12

Second question should be asked is dialysis and why ?

Answer 12

Did you do dialysis ?
If yes ,
1. IV FISTULA in their arm may left or right : don’t touch this arm in blood test , pressure measurement , or putting pressure on it .

2. Ask about time , how much per week .

Question 13

Why we must ask about dialysis timing , emergency cases ?

Answer 13

1. At the same day DONT WORK (high bleeding risk ) work day after .
2. At same day and before dialysis don’t work cause analgesics or any given drung will be excreted.
3. Emergency = only 6 hours after ( we wait until heparin effect is decreased )

Question 14

At which day time preferred to be the appointment ?

Answer 14

At morning , to avoid high BP
IF any thing went storage , he start to be different refer to emergency !

Question 15

What’s the chair position and anesthesia ?

Answer 15

Position , as it comfort for the patient
Anesthesia no restrictions

Question 16

Can nitrous oxide be given ?

Answer 16

Check before hemoglobin levels <10 if low don’t

Question 17

Bleeding ?

Answer 17

Day after dialysis , or 2 days before
Check CBC
CAN BE CONROLED BY : local pressure + bleeding stopper but not tablets

Question 18

What about analgesics ?

Answer 18

Minimal dose , better not NSAIDs and opioids

Only paracetamol 500mg 3 per day cause high doses lead to nephrotoxicity

Question 19

Antibiotics ?

Answer 19

Prophylaxis before procedure and after for a week

Dose need to be modified and calculated ( ask specialist )

Question 20

Vital signs ?

Answer 20

Check before , after procedure
Work after his doc permition

Question 21

What’s oral mucosa manifestations and why ?

Answer 21

1. Pillar , pigmentation , petechaie or oral mucosa due to anemia (mucosal pillar )
2. Mucosal ulcerations , infections ( periodontitis , candiasis , parotid injections ) due to weak immunity
3. White epithelial plaques , giant cell lesions of jaw ( secondary hypoparathyrodism )
4. Xerostomia , alter taste , halitosis
   5.trush , bacterial plaques

Question 22

What’s hard tissues manifestations ?

Answer 22

1. Enamel hypoplasia , hypocalcifications
2. Teeth mobility
3. Osteodystrophy

Question 23

70 years old male patient , known to have high creatinine of 1.3mg/dl and HTN , presented to your clinic for dental implant , would you preceed ?

Answer 23

Take full history .