Dental Management Chapter 12 Chronic Kidney Disease and Dialysis

2 hormones kidney release

Erythropoietin and Renin

There are more

Patients in Stage ___ require dialysis or transplant for survival.

5

Less than 15 ml/min

What is most common cause of ESRD (End Stage Renal Disease)

Diabetes Mellitus

Hyptertension is second

What are the early signs of renal failure

Na pump dysfunction

Excessive sodium excreted along with polyuria

Failing kidney cause hypertension due to _______ of fluid

overload

The buildup of nonprotein nitrogen compounds in the blood, mainly urea, as a consequence of loss of glomerular filtration function, is called ______

This is measured using _______

azotemia

BUN (Blood Urea Nitrogen)

ESRD causes metabolic _______ leading to _____ventilation

acidosis, hyperventilation

Renal Osteodystrophy is in ESRD due to _______ intestinal absorption of _______

The resulting low levels of serum ionized calcium stimulate secretion of _______

decreased, calcium

PTH (Enhance vitamin D absorption for calcium metabolism)

Problem is that calcium absorption in gut is still inhibited

Patients with CKD may show few clinical signs or symptoms until the condition progresses to Stage _____

3

The ______ is the best measure of overall kidney function, and the most significant protein in the urine is _______

GFR, albumin

Why is BUN not specific for kidney

Liver function also affect BUN

2 types of Peritoneal Dialysis

CAPD

APD

Continuous ambulatory: more common

Automated

Peritoneal Dialysis vs Hemodialysis

Peritoneal Advantage: Low cost, ease, reduced likelihood of infection.

Peritoneal Disadvantage: Require frequent session, risk of hernia

Hemodialysis Advantage: Most used, long term, forearm

Hemodialysis Disadvantage: Take long time, require heparin to prevent clotting, infection

With CKD of Stage ____ or higher, consultation with the patient's physician is suggested before dental care is provided.

4

Antibiotic in CKD

Stage 1-3 don’t require additional antibiotic (no dialysis)

Stage 4-5 consult physician

Why is Desmopressin avoided in CKD

It is antidiuretic worsen bleeding endencies

What is cryoprecipitate

Plasma derivative rich in clotting factor

Use in guidance of hematologist

In patients whose kidney function is deteriorating (GFR <____mL/min), elective dental care should be delayed until consultation is obtained and the patient is medically stable.

50

________ also is nephrotoxic and may cause renal tubular necrosis at high doses, but it is probably safer than aspirin in these patients when used for a short time frame because ________ is metabolized in the liver.

Acetaminophen, Acetaminophen

What is tramadol

Narcotic for analgesic

Alternative for CKD

Nitrous oxide and diazepam are antianxiety agents that require _______ modification for use in patients with ESRD.

Drugs that depress the central nervous system (barbiturates, narcotics) are best avoided in the presence of ______ because the blood–brain barrier may not be intact, so excessive sedation may result.

little

uremia

Patients with CKD who take calcium channel blocker (a hypotensive medication) may exhibit gingival enlargement. This condition also is seen in renal transplant recipients who take _______. The clinical presentation is similar to that caused by phenytoin (Dilantin).

cyclosporine (immunosuppresant)

Which dialysis should dentist most worry about

Hemodialysis (susceptible to infective endocarditis)

Also possible blood-borne disease

When should antibiotic be given to hemodialysis pt

When abscess is incised and drained

Where should blood pressure cuff be for hemodialysis

away from that arm with shunt

67-year-old male

Chief complaint

“Loose teeth”

Background and/or patient history

Smokes one pack of cigarettes/day for past 50 years

Hypertension

Diabetes type 2

HPI: Teeth loose, but nonpainful. Has not had routine dental care in over 10 years due to insurance issues.

PMH: Hypertension, hyperglycemia, abdominal obesity, snoring

Allergies: None

Current findings

Height: 5′ 11″

Weight: 220 lbs

BP: 149/85

Medications

Takes atorvastatin, captopril, citalopram, HCTZ, hydralazine

1. This patient's GFR is 65. What stage kidney disease is this?

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

______________________

2. At this stage of kidney disease, you would expect this patient to display several features including significant weight loss and fever. Anemia is a common feature of renal failure and dialysis and can be treated with recombinant human erythropoietin.

a. Both statements are True

b. Both statements are False

c. First statement is True, second statement is False

d. First statement is False, second statement is True

______________________

3. His teeth are likely loose because of

a. dental caries

b. periodontal disease

c. hypophosphatasia

d. hyperparathyroidism

______________________

4. Patients with ESRD demonstrate several hematologic abnormalities, including all of these but one. Which one is the exception?

a. anemia

b. platelet dysfunction

c. coagulopathy

d. leukocytosis

______________________

5. A feature of a bleeding tendency is

a. bruising

b. clubbing of the fingers

c. bone marrow expansion

d. loose teeth

B, D, B, C, A

75-year-old female

Chief complaint

“Wants a set of dentures”

Background and/or patient history

Hypertension

Diabetes type 2

Kidney failure and hemodialysis

Myocardial infarction 1 year ago

Current findings

Height: 5′ 1″

Weight: 120 lbs

BP: 169/85

Pulse: 80 bpm

Medications

Benazepril (Lotensin), metformin, HCTZ

1. In this patient, dialysis would have been considered when her GFR dropped below

a. 90

b. 60

c. 45

d. 30

______________________

2. Her arteriovenous (AV) shunt

a. could collapse if blood pressure is taken on this arm

b. is often made of titanium

c. is a good site for dental administration of conscious sedation drugs

d. requires antibiotic prophylaxis prior to an invasive dental procedure

______________________

3. This patient is not safe to provide dental treatment because of her past history of a myocardial infarction and her ongoing hemodialysis treatment.

a. True

b. False

c. Only if the myocardial infarction was a STEMI

d. Only if her A1c is above 8.0

______________________

4. Which of the following is a nephrotoxic drugs to avoid in this patient?

a. Acetaminophen

b. Amoxicillin

c. Diazepam

d. Tetracycline

______________________

5. Hemodialysis is a life-saving treatment for ESRD. Patients should receive dental treatment on the same day they receive hemodialysis.

a. Both statements are True

b. Both statements are False

c. First statement is True, second statement is False

d. First statement is False, second statement is True

D, A, B, A, D