Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dental Management of the Medically Complex Patient > Kidney Disease > Flashcards

Kidney Disease Flashcards

1
Q

what forces glomerular filtration

A

the hydrostatic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

20% of the renal plasma flow is filtered into:

A

bowmans capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what factors contribute to the filtration rate

A

hemodynamic factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is GFR affected by

A

renal artery pressure and other autoregulation factors of GFR such as:
- vasoreactice (myogenic) reflex of the afferent arteriole
- tubuloglomerular feedback (TGF)
- angiotensin II mediated vasoconstriction of the efferent arteriole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does the vasoreactice (myogenic) reflex of the afferent arteriole do

A

causes dilation or constriction of the afferent arteriole to maintain stable glomerular pressure in response to variations in systole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what does tubuloglomerular feedback do

A

causes dilation or constriction of the afferent arteriole to maintain stable glomerular pressure in response to solute concentration changes detected by macula densa cells in the distal/ascending loop of henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

where in the nephron does angiotensin II constrict

A

at the glomerulus and proximal convoluted tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the functions of the kidney

A
  • water regulation
  • electrolyte regulation
  • extracellular volume/pressure regulation
  • acid- base homeostasis
  • endocrine/metabolic
  • blood plasma filtration
  • excretion of metabolic waste
  • urine production
  • prostaglandin production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the endocrine hormones/things secreted by the kidney

A
  • kinins
  • erythropoietin
  • phosphate
  • vitamin D
  • renin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the function of blood plasma filtration of the kidney

A
  • glucose and amino acid reabsorption
  • calcium and phosphate regulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what metabolic waste is excreted by the kidney

A

nitrogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what do prostaglandins produced by the kidney do

A
  • regulate tubular and hemodynamic transport
  • possibly fibroblast production in an immune response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is another name for acute renal failure

A

acute renal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is ARF

A

a condition in which the kidneys suddenly cant filter waste from the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what does uremia result from

A

the cumulative effects of renal failure, retention of excretory products, and interference with metabolic and endocrine function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how long does ARF develop in, is it fatal, and who is it common in

A
  • develops rapidly over a few hours or days
  • may be fatal
  • most common in those who are critically ill and already hospitalized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the symptoms of ARF

A
  • decreased urinary output
  • swelling due to fluid retention
  • nausea
  • fatigue
  • SOB
  • sometimes symptoms may be subtle or not appear at all
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the only specific symptom of ARF

A

decreased urinary output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the causes of acute renal failure

A

-pre renal
- intrinsic renal
- post renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

describe prerenal ARF

A
  • hypovolemia
  • decreased CO
  • decreased effective circulating volume: CHF, liver failure
  • impaired renal autoregulation: NSAIDs, ACE-I/ARB, and cyclosporine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what meds can lead to ARF

A
  • ACE-I: monopril, captopril, enalapril
  • ARB: angiotensin receptor blocker, Diovan, Cozaar, Benicar
  • NSAIDs: indomethacin
  • PPI: proton pump inhibitors Prilosec, Prevacid, and Nexium
  • TTP-HUS: thrombotic thrombocytopenic purpura- hemolytic uremic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

nexium is also linked to:

A

stomach cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the instrinsic causes of ARF

A
  • glomerular: acute glomerulonephritis
  • tubules and interstitium
  • vascular: vasculitis, malignant hypertension, TTP-HUS
    all of these lead to:
  • ischemia
  • sepsis/infection
  • nephrotoxins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the nephrotoxins that cause ARF

A
  • exogenous: iodinated contrast, aminoglycosides, cisplatin, amphotericin B, PPIs, NSAIDs
  • endogenous: hemolysis, rhabdomyolysis, myeloma, intratubular crystals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the postrenal causes of ARF

A
  • bladder outlet obstruction
  • bilateral pelvoureteral obstruction (or unilateral obstruction of a solitary functioning kidney)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the treatments for ARF

A
  • address the underlying cause
  • cardiology and hepatology consultation
  • fluids
  • medication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the causes of chronic kidney disease

A
  • chronic glomerulonephritis
  • systemic lupus erythematosus
  • neoplasms
  • polycystic kidney disease
  • AIDS nephropathy
  • diabetic nephropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is epistaxis

A

nose bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are the risk factors for CKD

A
  • age - over 60 years of age
  • smoking
  • obesity
  • HTN- poorly controlled
  • diabetes: 40-50% of patients with type 2 DM will develop CKD
  • nephrotoxins/drugs
  • infections
  • low birthweight
  • chronic inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the diabetic kidney disease pathogenesis

A
  • nephron hypertrophy and/or nephron loss
  • glomerular filtration impairment
  • renal fibrosis leading to decreased GFR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the CKD diagnostic criteria

A
  • GFR: less than 60 mL/min/1.73 m^2
  • urinary albumin/creatinine ratio: greater than or equal to 30 mg/g
  • urinary albumin excretion rate: greater than or equal to 30mg/day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are diagnosis and classification of CKD based on

A

GFR and albuminuria/proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the GFR in end stage renal disease and what is the treatment

A
  • less than 15ml/min/1.73m^2
  • requires kidney replacement therapy - hemodialysis and transplantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

GFR steadily _____ with age

A

decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are the stages of CKD and the GFR

A
  • stage 1: normal kidney function- 90 or higher
  • stage 2: mild loss of kidney function: 89-60
  • stage 3a: mild to moderate loss of kidney function: 59-45
  • stage 3b: moderate to severe loss of kidney function: 44-30
  • stage 4: severe loss of kidney function: 29-15
  • stage 5: kidney failure: less than 15
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what stages of CKD start on dialysis

A

stage 4 and stage 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are the CKD complications

A
  • fluid and electrolyte imbalance
  • hypertension
  • cardiovascular disease
  • endocrine dysfunction
  • anemia
  • hyperuricemia
  • dyslipidemia
  • metabolic acidosis
  • mineral bone disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what are the fluid and electrolyte imbalance complications in CKD

A
  • dysregulation of Na+, K+, and H2O reabsorption
  • hyperkalemia
  • edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what are the hypertension complications in CKD

A
  • RAS activation
  • aldosterone and catecholamine activation
  • hypervolemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what are the anemia complications with CKD

A
  • Hb less than 12 g/dl for women and less than 13.5g/dl for males
  • decreased Epo and RBC survival
  • impaired iron absorption (insufficient hepcidin), blood loss (dialysis)
  • normocytic, normochormic anemia
41
Q

what are the hyperuricemia complications in CKD

A

uric acid and uremia (urea)

42
Q

what are the dyslipidemia complications of CKD

A
  • dysregulated metabolism of lipid and uremic toxic-mediated lipid alterations
  • atherosclerosis
43
Q

what are the metabolic acidosis complications of CKD

A
  • decreased excretion of NH4+
  • decreased absorption of H+ and HCO3-
44
Q

what are the mineral bone disorder complications associated with CKD

A
  • decreased vitamin D levels
  • dysregulation of Ca2+ and (PO4)3-
  • increased PTH and FGF23 levels
  • renal osteodystophy /secondary hyperparathyroidism
  • calciphylaxis- extraosseous calcifications: blood vessels of dermis and subcutaneous fat
45
Q

what are the manifestations of CKD in the jaw

A

brown tumors

46
Q

where are brown tumors found

A

in the maxilla and mandible but more common than the mandible

47
Q

what must be controlled in diabetic management in CKD

A
  • control DM: HbA1 less than 8%
  • control HTN: BP less than 140/90mmHg
  • control HLD: LDL less than 100 mg/dl
  • diet/lifestyle modification: BMI 18.5-24.9 kg/m^2
  • neuropathies
  • anemia
  • mineral bone disease
  • metabolic acidosis
  • hyperkalemia
48
Q

what drugs can be used to manage diabetic HTN

A
  • cardioselective beta blocker
  • diuretics
  • ACE inhibitor
  • ARB
  • calcium channel blocker
49
Q

what are the oral manifestations of CKD

A
  • xerostomia/dry mouth
  • halitosis
  • hysgeusia: metallic taste
  • infections
  • enamel defects in children
  • uremic stomatitis
  • petechiae and ecchymosis
  • osteodystrophy
50
Q

what oral infections are seen in CKD

A
  • opportunistic
  • periodontal
  • odontogenic
  • salivary
51
Q

describe uremic stomatitis in CKD

A
  • rare
  • BUN greater than 55 mg/dl
52
Q

what is osteodystrophy in CKD and what does it do

A
  • lack of hydroxylation of 25(OH)D to 1,25(OH)2D which takes place in the kidneys
  • causes lack of calcium absorption from intestines
  • stimulates parathormone secretion and calcium loss from bone
  • inhibits bone mineralization
53
Q

what are the causes of osteodystrophy

A
  • loss of lamina dura
  • demineralization (ground glass appearance)
  • expansile radiolucencies (CGCG, brown tumor)
  • wide trabeculae
  • loss of cortication
  • sclerosis
54
Q

osteodystrophy has similar bone changes to:

A
  • osteitis deformans (Paget’s disease)
  • fibrous dysplasia
55
Q

what does alternative filtering of the blood do and what is it initiated in

A
  • removes uremic toxins
  • initiated in ESRD
56
Q

what are the two modalities of alternative filtering of the blood

A
  • hemodialysis (venous access)
  • peritoneal dialysis
57
Q

describe hemodialysis and how often it is done and what are the downsides

A
  • arteriovenous fistula
  • arteriovenous graft
  • central venous catheter (special, short term)
  • machine filters blood
  • heparin is typically used
  • every 2-3 days (three/week) ; 3-4 hours/session
  • risk of infectious disease - Hep B and C
  • induces fatigue and dizziness
58
Q

describe peritoneal dialysis and how often is it done

A
  • hypertonic solution in peritoneal cavity
  • peritoneal membrane used for exchange
  • 3-5x/day or overnight
59
Q

when is dental treatment done in relation to hemodialysis

A

the day after

60
Q

what must match in kidney transplant, what is the life expectancy

A
  • ABO matching
  • HLA matching
  • can be from live (better) or decreased donor
  • related mismatched donor (3/6 match) is better than deceased donor
  • greater than 5 year life expectancy
61
Q

what are the absolute contraindications for a kidney transplant

A
  • AIDS
  • active hepatits
62
Q

what causes rejection in kidney transplants and are they direct or indirect causes

A
  • activated cytotoxic T cells (direct)
  • alloantibodies (direct)
  • delayed type hypersensitivity- arteriosclerosis of transplant (indirect)
63
Q

kidney organ transplants require:

A

immunosuppression

64
Q

what are the induction medications for kidney transplants and why are they used

A
  • to prevent acute rejection
  • antithymocuyte globulin
  • alemtuzumab (anti-CD52)
65
Q

what are the maintenance drugs for kidney transplants

A
  • azathioprine
  • mycophenolate mofetil
  • steroids
  • calcineurin inhibitors
  • mTOR inhibitors
  • belatacept
66
Q

what is azathioprine and what does it do

A
  • antimetabolite
  • inhibits DNA and/or RNA synthesis
67
Q

what is mycophenolate mofetil similar to and what does it do

A
  • similar to azathioprine
  • less bone marrow suppresion
68
Q

how are steroids used in maintenance of kidney transplant

A

low doses, adjunct

69
Q

what are the calcineurin inhibitors, what do they do and what diseases are complications seen in

A
  • cyclosporin
  • tacrolimus
  • both decrease production of IL-2 mRNA and proinflammatory cytokines
  • diabetes and nephrotoxicity complications
70
Q

what are the mTOR inhibitors and what do they do

A

-sirolimus
- everolimus
- inhibits T cell proliferation signaling

71
Q

what does belatacept do

A
  • binds costimulatory molecules
  • t- cell anergy and apoptosis
72
Q

what are the adverse effects of kidney transplant

A
  • cytopenias (bone marrow suppression)
  • bleesing: severe thrombocytopenia less than 50K
  • susceptibility to infection: severe leukopenia/neutropenia. WBC less than 200 and ANC less than 500
  • increased risk of developing skin and hematologic cancers
73
Q

what are the oral adverse effects of kidney transplants

A

gingival hyperplasia (cyclosporine)
- aphthous like ulcers (mTORi)

74
Q

what are the dental treatment considerations with renal disease

A
  • determine level of renal impairment and disease control
  • level of renal impairment may affect bleeding-assess risk
  • asses indication for antibiotics
  • drug interactions/side effects
75
Q

what is the level of renal impairment and disease control determined by in dental treatment considerations

A
  • BP
  • GFR
  • BUN
  • creatinine clearance
  • serum creatinine
  • electrolytes
76
Q

describe the level of renal impairments that may affect bleeding in dental treatment

A
  • patients can be at risk for both bleeding and thrombosis
  • quantitative and qualitative platelet impairment: platelet count, PT-INR, PTT
  • hemostatic measures as necessary
  • be aware of signs and symptoms of thrombosis
  • referral to a specialized center as necessary
77
Q

advanced uremia ->

A

decreased immune function

78
Q

how should infections in dental treatment in renal disease be treated

A

aggressively

79
Q

if invasive procedures in patients with stage 4 severe or end stage renal disease what should you do

A

consult physician about need for antibiotics

80
Q

is antibiotic prophylaxis routinely necessary for peritoneal dialysis

A

no

81
Q

is antibiotic prophylaxis necessary for patients with a synthetic AV graft

A

may be

82
Q

is antibiotic prophylaxis necesssary in hemodialysis patients if performing incision and drainage

A

yes

83
Q

what are the considerations with drug interactions and side effects

A
  • check drug excretion mechanism
  • carefully review possible drug interactions with current medication list when prescribing new medications
  • consult with patients physician
84
Q

what drugs should you be cautious about with renal disease

A

nephrotoxic drugs such as acyclovir, NSAIDs, aspirin, aminoglycosides and tetracycline

85
Q

how should acetominophen be used in renal disease

A
  • nephrotoxic at high doses
  • increase dosing interval
  • every 6 hours if GFR is greater than 10 but less than 50 ml/min
  • every 8 hours if GFR is less than 10ml/min
86
Q

how should NSAIDs be used in renal disease

A
  • avoid
  • except for aspirin for CVD
  • especially long term use
  • interaction with antihypertensives
  • impairment of prostaglandin production: vasoconstriction, reduced renal perfusion
87
Q

how should opioids be used in renal disease

A
  • avoid completely
  • risk for accumulation of toxic metabolites
  • ?tramadol with dose adjustment and/or increased dosing internal
  • consult with physician
88
Q

how should benzodiazepines be used in renal disease

A
  • caution
  • consider half life, active metabolite
  • single dosing, consult with physician
89
Q

how should acylovir be used in renal disease

A
  • increase dosing interval q8h or q12h
90
Q

how should antibiotics be used in renal disease

A
  • no adjustment required for: clindamycin, doxyclycline, erythromycin, metrondiazole
  • adjustment required:
  • amoxicillin - q12h or q24h
  • cephalexin: q6-18h or q12-24h
  • azithromycin- avoid if GFR less than 10
91
Q

how should fluconazole be used with renal disease

A

reduce to 50% or 25% of original dose

92
Q

how should nystatin be used in renal disease

A

no adjustment

93
Q

what are the goals of pre-transplant dental clearance

A
  • remove active foci of infection and limit potential foci of infection - think 6 months
  • defer elective treatment within first 6 months post transplant
94
Q

how should you remove active foci of infection and limit potential foci of infection

A
  • treat active foci of infection: SRP, endo tx, restorations
  • extract teeth with questionable/poor prognosis
  • assess caries risk and need for adjunts (fluoride)
  • educate patient on importance of maintaining good homecare, diet and professional maintenance
95
Q

how should renal disease patients be monitored

A
  • opportunistic infections
  • toxicities/side effects of systemic treatment
  • cancer
96
Q

what opportunistic infections must be monitored in renal disease

A
  • odontogenic
  • candidiasis
  • aspergillosis
  • HSV
  • OHL
  • CMV
97
Q

what are the toxicities and side effects of systemic treatment that need to be maintained in renal patients

A
  • adrenal insufficiency - long term high dose corticosteroids
  • gingival hyperplasia- cyclosporine
  • pyogenic granuloma and OFG like lesions- tacrolimus
  • oral ulcerations- sirolimus
98
Q

what cancers do we need to monitor in renal patients

A
  • non melanoma skin cancer- basal cell and SCC
  • post transplantation lymphoproliferative disorder- usually EBV associated, B cell
  • other solid cancers including oral SCC
99
Q
A

Dental Management of the Medically Complex Patient (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions