Chronic Kidney Disease and Dialysis Flashcards

Flashcards about Chronic Kidney Disease and Dialysis

End-stage renal disease (ESRD) is caused by…

Conditions that destroy nephrons

Four most common causes of ESRD

Diabetes mellitus, hypertension, chronic glomerulonephritis, and polycystic kidney disease

Highest risk factor for chronic kidney disease (CKD)

Age older than 60 years

Kidney Functions

Regulate fluid volume, Filter waste and toxins, Maintain acid-base balance of plasma, Synthesize and release hormones, Responsible for drug metabolism

Functional unit of the kidney

Nephron

Definition of CKD

Abnormalities of kidney structure or function, present for 3 months or longer

Progressive disease that can lead to death

Uremia and kidney failure

The National Kidney Foundation defines a five-stage classification system for CKD based on the…

Glomerular filtration rate (GFR)

Stage 1 CKD

Normal or only slightly increased GFR associated with some degree of kidney damage. Usually asymptomatic, with a slight decline in renal function.

Stage 3 CKD

Moderately decreased GFR (30-59 ml/min), with loss of 50% or more of normal renal function

Stage 5 CKD

Renal failure, wherein 75% or more of the approximately 2 million nephrons have lost function (GFR <15 ml/min)

Uremia

Raised level in the blood of urea and other nitrogenous waste compounds, a clinical syndrome caused by renal failure, retention of excretory products, and interference with endocrine and metabolic functions.

Early stages of CKD (stages 1-3)

Tend to be asymptomatic

Nephron includes…

The glomerulus, tubules, and vasculature

Normal kidney function is maintained until…

50% of nephrons are destroyed

Tubular malfunction

Sodium pump loses its effectiveness, leading to sodium and excessive amounts of dilute urine excreted (polyuria).

Azotemia

The buildup of nonprotein nitrogen compounds in the blood (Mainly urea due to loss of glomerular filtration function), level of which measured as blood urea nitrogen (BUN).

Manifestations of ESRD may include

anemia, compromised host defense, hemorrhagic diatheses, compromised coronary artery blood flow.

Renal osteodystrophy

Bone disorders seen in ESRD, caused by decreased kidney function affecting vitamin D hydroxylation and calcium absorption.

Renal Failure Manifestations

Can involve multiple systems; >40% of patients have diabetes, and >25% have concurrent hypertension

Signs and symptoms of CKD at Stage 3 and beyond

General ill feeling, loss of appetite, and weight loss, anemia, leg cramps, insomnia, dark urine and nocturia, convulsions (late manifestation) due to azotemia.

Signs and symptoms of CKD at Stage 3 and beyond may also include

Oral ulceration and candidiasis, bleeding diatheses, hyperpigmentation of the skin (brownish-yellow), hypertension, congestive heart failure, and pericarditis.

Urinalysis

Looks for proteinuria, hematuria, cellular casts, specific gravity, and pH.

Key measures for determining CKD severity

GFR and albuminuria

Medical management for Stage 1 and 2 CKD

Retard the progress of disease through dietary modifications (low protein, limiting fluid, sodium, and potassium) and controlling comorbid conditions

Indication to start dialysis

When uremic features appear or intractable fluid overload occurs

Dialysis

The artificial filtration of blood, necessary when GFR drops below 30 ml/minute/1.73 m^2

Peritoneal dialysis

Hypertonic solution is instilled into the peritoneal cavity through a permanent peritoneal catheter, then the solution and dissolved solutes are drawn out.

Hemodialysis

Method of choice when azotemia occurs, performed every 2 or 3 days, patients lead relatively normal lives between sessions.

During hemodialysis…

Blood is passed through the machine, filtered, and returned to the patient. Heparin is administered to prevent clotting.

Complications of dialysis may include…

Muscle tetany, oversecretion of PTH, dialysis-related amyloidosis, anemia, risk of hepatitis/HIV, infection of arteriovenous fistula

Considerations for dental management of patient under conservative care include

High-risk groups (i.e., patients with diabetes and hypertension) recommended to be screened for CKD, and patient with signs and symptoms of kidney disease referred to a physician

Antibiotic considerations for CKD in stages 1-3

These patients do not require additional antibiotic considerations unless an invasive procedure is being performed

Considerations for bleeding in patients with CKD…

invasive procedure requires pretreatment screening and abnormal values discussed with the physician. Local hemostatic agents are used on patients with uremia.

Dental care should be delayed until medical stability

If GFR is <50 ml/min

Avoid nephrotoxic drugs such as…

Acyclovir, aminoglycosides, aspirin, NSAIDs, and tetracycline

Oral complications and manifestations of CKD include…

Red-orange discoloration of cheeks and mucosa, xerostomia, altered/metallic taste, ammonia-like odor, poor oral hygiene, halitosis, gingivitis, periodontal disease, tooth loss.

Uremic stomatitis

Rare, red burning mucosa covered with grey exudates and later frank ulceration; adherent white patches called uremic frost

Tooth-specific changes in CKD include…

Enamel hypoplasia and hypocalcification, red-brown discoloration, erosion, pulp narrowing; caries is typically not a feature.

Osseous changes of the jaws may include…

Loss of lamina dura, demineralized bone giving a ground-glass appearance, expansile radiolucent jaw lesions, widened trabeculations, loss of cortication, calcified extraction sites, and metastatic calcifications

Treatment planning modifications for CKD

Oral hygiene instruction, periodic recall appointments, frequent professional prophylaxis, and antiplaque measures.

Dialysis considerations for risk assessment include

Dialysis type, degree of kidney dysfunction, comorbidities, oral health, and dental procedure planned.

Antibiotic recommendations for patients receiving dialysis

American Heart Association's 2003 guidelines do not include a recommendation for prophylactic antibiotics before invasive procedures.

Management modifications for bleeding in patients receiving dialysis

Treatment after dialysis, primary closure, pressure, local hemostatic agents, potentially reduce heparin dose, consider protamine sulfate.

Capacity to tolerate care for patients receiving dialysis

Assess comorbid conditions, provide care only when medically stable.

Factors governing whether a drug will be dialyzed include

Molecular weight, molecular size, volume of drug distribution and endogenous drug clearance.

Oral complications and manifestations of hemodialysis include…

Uremic odor, dry mouth, taste change, tongue and mucosal pain, petechiae, ecchymoses, higher plaque and calculus indices; secondary hyperparathyroidism and osseous changes.

Management precautions for patients with renal transplant include…

Corticosteroids or antibiotic prophylaxis, management of oral infection and gingival overgrowth