SPECIAL CARE renal disorders

Question 1

list renal functions?

Answer 1

• excretion of waste products
• maintaining fluid and electrolyte balance
• acid-base balance
• secretion of hormones (renin, erythropoitin, activate vitamin D)
• excretion of drugs

Question 2

describe the 2 types of renal failure?

Answer 2

acute - after surgery/ severe injury/ renal blood vessels become obstructed
chronic - develops slowly

Question 3

what causes chronic kidney disease?

Answer 3

kidney damage
reduction in GFR for 3 or more months

diabetes, hypertension, glomerulonephritis

Question 4

what tests are done for kidney function?

Answer 4

blood tests
urine tests

Question 5

when do chronic kidney disease symptoms arise?

Answer 5

when kidney function is less than 25% of normal

Question 6

what are the stages of chronic kidney disease?

Answer 6

• normal
  1 early CKD
  2 mild CKD
  3 moderately severe
  4 severe CKD
  5 end stage renal failure

Question 7

what is the clinical presentation of renal failure?

Answer 7

depression, lethargy
nausea, vomiting, anorexia
weakness, fatigue
peptic ulceration
bruising
diarrhoea
bone pain

Question 8

what are the oral findings of chronic kidney disease?

Answer 8

osseous lesions
dry mouth, metallic taste, halitosis
reduced salivary flow, protein and electrolyte changes
accelerated calculus production
pale oral mucosa
oedema, oral ulceration
paraesthesia

Question 9

what issues may arise with a patient who has chronic kidney disease, in relation to dental management?

Answer 9

bleeding tendency
increased risk of infections
poorly controlled infections may spread and cause septicaemia

Question 10

what are the dietary guidelines for CKD?

Answer 10

limit salt and potassium to control blood pressure
limit phosphorus as pulls calcium from bones
limit potassium - can cause heart problems
eat the right amount and the right types of protein
fluid restriction - stages 4 and 5 CKD (depends on residual kidney function, type of dialysis and diuretic therapy)

Question 11

what are the 2 types of renal dialysis?

Answer 11

haemodialysis
peritoneal dialysis

Question 12

where is haemodialysis performed?

Answer 12

in health centres or hospitals

Question 13

describe haemodialysis?

Answer 13

requires arterio-venous access
removes excess fluid and uraemic solutes
patient is heparinised

Question 14

what drugs do patients on haemodialysis take and why?

Answer 14

Heparin (blood thinner) - to stop blood clotting and fistulas forming

Question 15

how often do patients receive haemodialysis treatment?

Answer 15

3 times a week
4 hours

Question 16

where is peritoneal dialysis performed?

Answer 16

at home by patient or carer

Question 18

describe peritoneal dialysis?

Answer 18

a catheter is placed in the peritoneal cavity
dialysis fluid is exchanged at regular intervals

Question 19

what must be considered with pts on renal dialysis receiving dental treatment?

Answer 19

bleeding
infection
drug interactions
toxicity and dosage
must consult renal physician

Question 20

when is the best time to treat someone on renal dialysis?

Answer 20

the day after haemodialysis

Question 21

what must be checked before XLA for pts on renal dialysis?

Answer 21

FBC and coagulation screen
abx cover?

Question 22

what drugs should be avoided for pts on renal dialysis?

Answer 22

aspirin and other NSAIDs

Question 23

what is the role of the dental team in managing a pt pre-renal transplant?

Answer 23

full dental assessment
xla teeth of poor prognosis
cons
scaling
preventative regime
dentally fit
eradication sources of potential infection

Question 24

what dental conditions may present in a pt post renal transplant?

Answer 24

gingival hyperplasia (cyclosporine)
increased risk of oral tumours
candidiasis, herpes simplex

Question 25

can you treat someones teeth after a renal transplant?

Answer 25

must defer elective dental care for 6 months
consult with renal physician
ab cover within first 6 months

Question 26

how long do renal transplants last?

Answer 26

depends whether from living donor and how well matched the blood group and tissue type is
90% success at 1 year
70% survival at 5 years