Clinical Introduction to the Renal System

• how should you manage a patient after a transplant?

  - provide regular dental assessments

  - provide prophylactic fluoride to maintain dental health
• How do you dentally manage a transplant patient?

  If they develop a dental infection, it must be treated aggressively and maybe consider antibiotics for extractions.

  
  

  -> In those with gingival hyperplasia, oral ulceration, and oral candidaisis, they will already be on numerous drugs so survey them for risk of cancer
• What should you do to patients before they undergo renal transplant?

  they need a dental assessment to ensure they are dentally fit before any transplant.

  
  

  -> Remove any teeth that are not salvageable, or any infected ones, because after transplant, they will be immunosuppressed & they can't undergo dental treatment then
• what should you do if you find a cystic lesion in the jaw?

  - find bony expansion

  - DPT, CT scan, CBCT

  - biopsy: brown

  - histology: giant cells

  - abnormal Ca & PO4 in blood

  - diagnosis = browns tumour of hyperparathyroidism
• how do lesions occur in jaw of people with chronic kidney disease?

  due to altered calcium metabolism (as a result of renal disease in this case)
• why is the contrast material for a CT/MRI scan a risk?

  it's nephrotoxic
• What should you do if you see anything unexpected on a radiograph?

  Take history, examination, differential diagnoses, investigate (DPT, CT scan, biopsy, bloods), get a diagnosis, commence treatment
• what does the adjusting of medication depend on?

  - the extent of the renal disease

  - the creatinine clearance (CC)
• Why should you be cautious as to what analgesia you prescribe to a patient with known CKD?

  Because if it's going to be metabolised by the kidneys, it's not the best choice.

  (avoid NSAIDS, Cox-2 inhibitors)
• what is analgesia?


  An analgesic drug, also called simply an analgesic, pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain
• What are some oral and other manifestations/signs of CKD?

  - Enamel hypoplasia (in children)

  - uraemic halitosis

  - altered taste

  - renal bone disease

  - anaemia
• What blood tests would you do for kidney disease?

  Urea, electrolytes, potassium , urea creatinine
• What should you ask about/check every time a patient with known CKD presents to you?

  - History present complaint

  - PMH

  - Stage of renal disease

  - Dialysis, type, frequency

  - Renal transplant

  - Medications (be aware of interactions and immunosuppression drugs)

  - Allergies
• Do patients on peritoneal dialysis also have to take anticoagulants?

  no
• what are the advantages of peritoneal dialysis?

  - independence

  - fewer stringent dietary restrictions

  - better rehabilitation rates
• How does peritoneal dialysis work?

  The peritoneum acts as a semipermeable membrane similar to a hemodialysis filter

  
  

  Available as continuous ambulatory (CAPD; four exchanges per day) or intermittent/cyclic (CCPD machine carries out exchanges overnight)
• How does haemodialysis work?

  Blood is filtered across a semipermeable membrane removing accumulated toxic waste products, solutes, excess fluid (ultrafiltration), and restoring buffering agents to the bloodstream
• why is it important for dentists to know if a patient is taking anticoagulants?

  because dental procedures cannot be carried out on anticoagulant patients as it may cause bleeding.
• which renal replacement requires anticoagulants to prevent blood clots?

  haemodialysis
• what are examples of renal replacement (at end-stage renal disease)?

  - haemodialysis

  - Peritoneal dialysis: continuous ambulatory or intermittent/cyclic

  - transplantation
• what must we do for high risk patients (with Diabetes mellitus, Hypertension, or recurrent UTIs ) of renal disease?

  monitor them
• give statistics about renal disease

  - 2.6 million people (>16yr) had CKD (2011) in England

  
  

  - 6.1% of the population of 16 yrs or older had renal disease

  
  

  - Globally > 2 million people have End Stage Renal Disease (2010)

  
  

  - 1/3 type 2 diabetics develop overt kidney disease
• Early kidney dysfunction may be asymptomatic.

  TRUE/ FALSE

  TRUE
• what can cause AKI or CKD?

  - drugs

  - nephrotic syndrome

  - urinary obstruction

  - infection

  - malignant hypertension

  - autoimmune disease

  - polycystic kidneys

  - diabetes

  - malignancy including myeloma
• What are the 5 stages of CKD?

  
• what is chronic kidney disease (CKD)?

  decline in renal function over time

  (irreversible)
• what are the forms of AKI?

  - prerenal:

  reduced blood flow to kidney

  
  

  - renal:

  reduction in kidney function (kidney damage)

  
  

  - postrenal:

  obstruction to urinary collection system
• what is acute kidney injury (AKI)?

  sudden decline in renal function

  (often reversible)
• what are the problems of an unhealthy kidney?

  - Fluid overload

  - Elevated wastes

  - Changes in hormone levels that controls BP, makes RBC's and takes up calcium.
• what are the functions of the kidney?

  - Excretion of waste (urea, uric acid, ammonia, PO4, potassium, creatinine...)

  - Homeostasis of body fluid volume and solute composition

  - Control of plasma pH

  - Hormone production: to control BP, make RBC's and take up calcium.