Renal Replacement

Question 1

Describe renal dialysis

Answer 1

A passive process - diffusion across concentration gradients
Allow intermittent correction of changes in plasma concentration of small molecules
Not true renal replacement - significant lifestyle restrictions remain
Two types - haemodialysis and peritoneal dialysis

Question 2

Describe renal endocrine replacement

Answer 2

Erythropoietin - replaced by EPO injections, maintains red cell mass
Bone mass maintenance - vitamin D supplementation, osteoporosis prevention programme
Hypertension control - renin-angiotensin system inactive, ACE inhibitors may have limited use

Question 3

Describe renal transplantation

Answer 3

Optimal treatment for ESRD 
Normal renal function
No dietary restrictions
Normal energy and fertility
HLA matched - may be family

Question 4

What are the problems with transplant

Answer 4

Rejection - acute or chronic
Immunosuppression - increased infection/malignancy risk
High cardiovascular mortality
Osteoporosis risk

Question 5

What are the causes of transplant failure

Answer 5

Acute rejection - 40%
Transplant glomerulopathy
Other
Interstitial fibrosis and tubular atrophy
Recurrence
BK nephropathy

Question 6

How should dental patients on renal dialysis be treated

Answer 6

Treat after haemodialysis sessions - not necessary for PD patients
Liaise with physician for drugs
Do nut use the dialysis shunt
No heroic treatment plans

Question 7

How may renal transplant cause dental problems

Answer 7

Normal renal function at first but may reduce with time - check creatinine levels
Complications are those of immune suppressants

Question 8

Which drugs can cause complications and interactions with renal transplant patients

Answer 8

Prednisolone
Azathioprine
Tacrolimus
Cyclosporin
Steroid side effects
Increased cancer risk - be suspicious of oral mucosal lesions