Renal diseases


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Oral Diagnosis I
Third Year

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Renal diseases

  1. 1. Oral Diagnosis-I Review of chronic renal failure and dialysis December 24, 2006 Dr. Suresh. C. S. BDS; MDS; MDSc (UK)
  2. 2. Chronic Renal Failure & Dialysis “Overview”  Kidney regulate fluid volume and acid base balance of the plasma  Excrete nitrogenous waste  Synthesize erythropoietin, 1,25- dihydroxycholecalciferol & renin  Drug metabolism  They are the target organs for parathormone & aldosterone
  3. 3. Chronic Renal Failure & Dialysis Definition  End stage renal disease (ESRD) is a bilateral progressive and chronic deterioration of nephrons (the functional unit of the kidney).  The disease results in uremia and can lead to death.  ESRD manifests when 50-75% of nephrons lose function.
  4. 4. Chronic Renal Failure & Dialysis Incidence & Prevalence  In US, 8 million people have some form of kidney disease, 360,000 have irreversible ESRD.  Average dental practice of 2000 patients can expect to have 2 patients with ESRD.  ♂>♀.  Age: 45-65.
  5. 5. Chronic Renal Failure & Dialysis Etiology  Diabetes mellitus 34%  Hypertension 25%  Chronic glomerulonephritis 16%  Other causes like:  Systemic lupus erythematosis  AIDS, Etc
  6. 6. Chronic Renal Failure & Dialysis Signs & Symptoms  Patient appears ill & anemic  Hemorrhagic episodes: ecchymosis, petechiae, purpura and gingival or mucous membrane bleeding (epistaxis)  Cardiovascular manifestations include:  Hypertension  Congestive heart failure (shortness of breath, dyspnea on exertion & peripheral edema)  Pericarditis
  7. 7. Chronic Renal Failure & Dialysis Signs & Symptoms (Cont.)  Hyperpigmentation of the skin (retention of carotene- like pigments normally excreted by the kidney)  Gastrointestinal signs:  Anorexia  Nausea  Vomiting  Generalized gastroenteritis  Peptic ulcer disease
  8. 8. Chronic Renal Failure & Dialysis Signs & Symptoms (Cont.)  Stomatitis manifested by oral ulceration & candidiasis.  Parotitis may be seen and a urine like odor to the breath may be detected.  Uremic syndrome commonly causes malnutrition and diarrhea.
  9. 9. Chronic Renal Failure & Dialysis Medical Management  The goals of treatment are to retard the progress of disease and preserve the patient’s quality of life  A conservative approach  Involve decreasing the retention of nitrogenous waste products  Controling hypertension, fluids & electrolyte imbalances  Anemia associated with renal failure usually is treated with the use of recombinant human erythropoietin
  10. 10. Chronic Renal Failure & Dialysis Medical Management (Cont.)  Dialysis  It is a medical procedure that artificially filters blood  It becomes necessary when the number of nephrons diminishes too much.  Every 2 or 3 days depending on need  Usually 3 to 4 hours are required for each session
  11. 11. Chronic Renal Failure & Dialysis Medical Management (Cont.)  Drugs that are metabolized primarily by the kidney should be avoided  Abnormal bleeding is associated with dialysis  Bleeding tendency because of altered platelets aggregation and decreased platelets factor III  5 years survival rate is 28%  An alternative is renal transplantation
  12. 12. Chronic Renal Failure & Dialysis Dental Management  Patients under conservative care  Consultation with patient’s physician  If patient is in advance stages, dental care may best be provided after physician’s consultation and in a hospital like setting.  Because of the potential for bleeding problems: o Pretreatment screening for bleeding time and platelet count. o A hematocrit level and hemoglobin count should be obtained to assess the status of anemia
  13. 13. Chronic Renal Failure & Dialysis Dental Management (Cont.)  If an orofacial infection exists, aggressive management is necessary using culture and sensitive tests and appropriate antibiotics  Nephrotoxic drugs should be avoided  Example: NSAID, Aspirin, and Tetracycline require special dosage adjustments
  14. 14. Chronic Renal Failure & Dialysis Dental Management (Cont.)  Patients receiving dialysis  Patients are at risk for infective endocarditis but the reason(s) are not yet fully established.  Infective endocarditis occurs in 2% to 9% of patients receiving hemodialysis  40% of patients on dialysis have congestive heart failure  Hemodialysis tends to aggravate bleeding tendencies • Physical destruction of platelets • Heparin usage
  15. 15. Chronic Renal Failure & Dialysis Oral Complications & Manifestations  Pallor of the oral mucosa secondary to anemia  Red-Orange discoloration of the cheeks and mucosa caused by pruritis and deposition of carotene-like pigments  Diminished salivary flow (parotid infections)  Candidiasis (xerostomia)
  16. 16. Chronic Renal Failure & Dialysis Oral Complications & Manifestations (Cont.)  Patients complain of an altered metallic tastes.  Uremic stomatitis.  Petechiae and ecchymosis on the labial and buccal mucosa, soft palate and margins of the tongue as well as gingival bleeding.  Osseous changes of the jaws.