Renal Diseases

Question 1

What is the renal function?

Answer 1

• Maintain normal body fluid volume and composition
• Essential for excretion and removal of waste and drugs

Question 2

Causes of loss of renal function?

Answer 2

• Renal disease (renal tract infection, hypertension, diabetes)
• Renal hypofunction (severe shock or haemorrhage)
• Blockage of renal outflow (kidney stones)

Question 3

What are the effects of CKD?

Answer 3

• Metabolic
• Cardiovascular
• Gastrointestinal
• Neuromuscular
• Haematological
• Skin
• Immunological

Question 4

What are the metabolic effects of CKD?

Answer 4

Glucose in urine and electrolyte disturbances, causing thirst and urine at night. This leads to dry mouth and increased risk of plaque build up and decay.

Question 5

What are the cardiovascular effects of CKD?

Answer 5

Hypertension (HBP) and atheroma (fatty build-up in arteries).
Medication for hypertension can cause gingival hyperplasia. This makes it harder to maintain oral hygiene for patients, causing periodontitis as well as false pocketing.

Question 6

What are the gastrointestinal effects of CKD?

Answer 6

• Loss of appetite causing weight loss.
• Nausea and vomiting leading to peptic ulcers (mucus membrane of stomach).
• Hiccups due to build up of toxins.
  These increase the risk of decay in patients due to the acid and erosion effects of vomiting and the lack of mastication means less saliva flow to naturally cleanse the teeth.

Question 7

What are the neuromuscular effects of CKD?

Answer 7

Headaches, drowsiness and tremors. This can cause lack of motivation to maintain oral hygiene.

Question 8

What are the haematological effects of CKD?

Answer 8

• Bleeding due to platelet dysfunction or anticoagulant medication. Dental appointments may need to be shortened due to excessive bleeding.
• Anaemia due to erythropoietin deficiency. Increased risk of decay, periodontitis and infections due to dry mouth.

Question 9

What are the skin effects of CKD?

Answer 9

Bruises, rashes and itchy skin

Question 10

What are the signs and symptoms of CKD?

Answer 10

• Swollen ankles, feet and hands due to water retention
• Weight loss due to poor appetite
• Increased need to urinate due to build-up of glucose in blood
• Dyspnoea (shortness of breath due to hypertension
• Bruises, rashes and itchy skin

Question 11

General (patient) management of CKD?

Answer 11

• Low protein diet
• Potassium restriction
• Salt and water control
• Dialysis or kidney transplant

Question 12

True or false..
Kidney transplant patients will need be immunosuppressed?

Answer 12

True
Due to being susceptible to infection

Question 13

What is the dental relevance to patients with CKD?

Answer 13

• Patients will require steroid cover due to being immunosuppressed
• Increased risk of infections such as; Herpes simplex (viral), or candidiasis and thrush (fungal)
• Increased risk of cancers; skin, lip, Kaposi’s syndrome
• Gingival hyperplasia due to hypertension medication
• Lymphoma (swollen glands)
• Dry mouth causing increased risk of periodontitis and decay
• Halitosis and metallic taste
• Enamel hypoplasia
• Delayed tooth eruption

Question 14

What is haematuria?

Answer 14

Presence of blood in urine

Question 15

What causes blockage of renal outflow?

Answer 15

Kidney stones or prostate tumours

Question 16

What is platelet dysfunction?

Answer 16

Disorder in which the platelets do not form strong blood clots, leads to increased risk of bleeding

Question 17

What haematological effect does a erythropoietin deficiency cause in CKD patients?

Answer 17

Anemia