Renal disease Flashcards
what is the anatomy of the kidney?
outer cortex
inner medulla
leading the pelvis and ureter
where are there diseases in the kidney?
pre renal
within the kindney itself
post renal
what are the functions of the kidney?
excretion of waste products including dental drugs
regulate fluid volume and acid/base
key in the maintenance of blood pressure
synthesis erythropoietin/ renin/1, 25 cholecalciferol
the target organ for parathormone/aldosterone/ADH
what does the normal kidney function like?
normally filer 100ml/min most is reabsorbed
normal urine production is 0.5-1.5 ml/kg/hr
GFR is estimated form blood creatine level, age,race and gender
what is the epidemiology of kidney disease?
asymptomatic until advanced disease
15% of the UK population over age 35. 40% of those affected are unaware
what are the main risk factors of chronic kidney disease?
hypertension and diabetes are the main risk factors
mainly affects Asian and black Caribbean
what are the stages of kidney disease?
5 stages
stages based on GFR
patients who are in stages 4 and 5 (<30% GFR) or have had a transplant or are on dialysis are at risk for dental treatments.
what are the consequences of kidney disease?
increased cardiovascular risk
anaemia (erythropoietin is affected ) and reduced immunity (high urate levels)
increased risk of bleeding
fluid imbalances
decreased bone health (affects 1, 25 cholecalciferol production)
build-up of toxins
reduced drug excretion
what are the dental implications of kidney disease?
increase in periodontal disease
signs of anemia
bone abnormalities
increased bleeding
care with used of ibuprofen
common dental drugs and CKD.
lidocaine - no alterations
articaine - no alterations
Amoxycillin - might need to be reduced dose towards the end stage
NSAID’s - avoid towards the end stage
erythromycin - avoid due to drug interactions
Midazolam - use with caution of stage 4+
what are the two types of dialysis?
-haemodialysis
-peritoneal dialysis
necessary once function is no longer able to meet demand GFR<10
END STAGE OF KIDNEY DISEASE
what is haemodialysis?
-performed three times a week
-requires vascular/venous accesses
-requires machine
-can be done at home
-anticoagulation on dialysis days
-time consuming
how does haemodialysis work?
-patient blood is taken out and goes through a pump
-enters the machine, in the dialysis machine there is a semi-permeable membrane
-the toxins diffuse from the high concentration in the blood to the low concentration in the dialysate
-blood is then returned
how does peritoneal dialysis work?
-a catheter is placed in the abdominal space
- fluid is injected
- acts as a dialysis membrane
- toxins are removed
how do you perform dental procedures on haemodialysis patients?
in the morning of the non-dialysis day
local haemostatic measures
patients may require antibiotic prophylaxis due to an immune defect
keep in contact with the renal team
don’t place needles of measure BP in the AVF arm
