SPECIAL CARE renal disorders Flashcards
list renal functions?
- excretion of waste products
- maintaining fluid and electrolyte balance
- acid-base balance
- secretion of hormones (renin, erythropoitin, activate vitamin D)
- excretion of drugs
describe the 2 types of renal failure?
acute - after surgery/ severe injury/ renal blood vessels become obstructed
chronic - develops slowly
what causes chronic kidney disease?
kidney damage
reduction in GFR for 3 or more months
diabetes, hypertension, glomerulonephritis
what tests are done for kidney function?
blood tests
urine tests
when do chronic kidney disease symptoms arise?
when kidney function is less than 25% of normal
what are the stages of chronic kidney disease?
- normal
1 early CKD
2 mild CKD
3 moderately severe
4 severe CKD
5 end stage renal failure
what is the clinical presentation of renal failure?
depression, lethargy
nausea, vomiting, anorexia
weakness, fatigue
peptic ulceration
bruising
diarrhoea
bone pain
what are the oral findings of chronic kidney disease?
osseous lesions
dry mouth, metallic taste, halitosis
reduced salivary flow, protein and electrolyte changes
accelerated calculus production
pale oral mucosa
oedema, oral ulceration
paraesthesia
what issues may arise with a patient who has chronic kidney disease, in relation to dental management?
bleeding tendency
increased risk of infections
poorly controlled infections may spread and cause septicaemia
what are the dietary guidelines for CKD?
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)
what are the 2 types of renal dialysis?
haemodialysis
peritoneal dialysis
where is haemodialysis performed?
in health centres or hospitals
describe haemodialysis?
requires arterio-venous access
removes excess fluid and uraemic solutes
patient is heparinised
what drugs do patients on haemodialysis take and why?
Heparin (blood thinner) - to stop blood clotting and fistulas forming
how often do patients receive haemodialysis treatment?
3 times a week
4 hours
where is peritoneal dialysis performed?
at home by patient or carer
describe peritoneal dialysis?
a catheter is placed in the peritoneal cavity
dialysis fluid is exchanged at regular intervals
what must be considered with pts on renal dialysis receiving dental treatment?
bleeding
infection
drug interactions
toxicity and dosage
must consult renal physician
when is the best time to treat someone on renal dialysis?
the day after haemodialysis
what must be checked before XLA for pts on renal dialysis?
FBC and coagulation screen
abx cover?
what drugs should be avoided for pts on renal dialysis?
aspirin and other NSAIDs
what is the role of the dental team in managing a pt pre-renal transplant?
full dental assessment
xla teeth of poor prognosis
cons
scaling
preventative regime
dentally fit
eradication sources of potential infection
what dental conditions may present in a pt post renal transplant?
gingival hyperplasia (cyclosporine)
increased risk of oral tumours
candidiasis, herpes simplex
can you treat someones teeth after a renal transplant?
must defer elective dental care for 6 months
consult with renal physician
ab cover within first 6 months
how long do renal transplants last?
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
