renal failure and dialysis + arthritis + Adrenal Insufficiency + Stroke

Most common cause of chronic renal failure

Diabetes Mellitus

What percentage of nephrons must be destroyed before renal function is affected?

50-70%

State the cause of death in end stage renal failure

Sepsis

What is the best treatment for chronic renal failure?

Kidney translplant

What percentage of normal renal function is provided by dialysis

15%

What are the risks with dental treatment due to renal failure?

infection, bleeding, prescribed drugs

What two issues should be addressed when requesting a med consult for a pt with chronic renal failure?

Bleeding risk and dosage adjustment

Which steroid is related to adrenal insufficiency?

Glucocorticosteroids

What is the normal daily output of cortisol equivalent to hydrocortisone?

20-25mg/day

What is the maximum output of cortisol during periods of stress equivalent to hydrocortisone

120-250mg/day

What is the most common cause of primary adrenocortical insufficiency?

Addison’s Disease

What percentage of the adrenal cortex must be destroyed before clinical evidence occurs?

90%

What is the most common cause of secondary adrenocortical insufficiency?

Tumors

What is the most common cause of tertiary adrenocortical insufficiency

Chronic exogenous corticosteroid use

What are the three side effects of chronic steroid use that are a concern to the dentist?

Suppression of steroid production, increased infections, poor would healing.

What is the cause of death in the case of extreme adrenal insufficiency?

Cardivascular collapse

What time frame has the greatest after a first stroke or TIA

after 90 days

Why are pts who had a stroke at a higher risk for bleeding?

They may be taking anticoagulants

At what level of INR is dose reduction not requried?

INR < 3.5

Which two antibiotics can increase pt’s INR and risk of bleeding?

metronidazole and tetracycline