This document discusses medical emergencies related to renal disorders and their oral manifestations. It covers various renal diseases including renal failure, glomerular diseases, and end stage renal disease. For patients with impaired renal function, oral manifestations can include xerostomia, parotitis, pigmentation, enamel hypoplasia, and candidiasis. Management of dental treatment for these patients requires consulting their physician, carefully monitoring blood pressure and drug dosages, and preventing infections. Special considerations are outlined for patients undergoing dialysis, renal transplants, or who have received a transplant.
8. An inflammation of the glomerular
capillaries
Acute nephritic syndrome
Chronic glomerulonephritis
Nephrotic syndrome
GLOMERULAR DISEASES
9. Acute and reversible deterioration of
renal function which develops over a
period of days, or rarely weeks and
results in uremia is called acute renal
failure
ACUTE RENAL FAILURE
10. Hypovolemia
Hypotension
Reduced cardiac output and heart
failure
Obstruction of renal arteries or veins
Obstruction of the kidney or lower
urinary tract
CAUSES
11. Chronic renal failure is the irreversible
deterioration in renal function which results
from a diminished mass of the excretory,
metabolic and endocrine functions of the
kidney which leads to the development of
the clinical syndrome of uremia
CHRONIC RENAL FAILURE
12. Diabetes mellitus
Hypertension
Chronic glomerulonephritis,
Pyelonephritis or other infections
Obstruction of urinary tract
Hereditary lesions
Vascular disorders
Medications or toxic agents
CAUSES
14. Consultation with patient’s physician
Avoid dental treatment if disease is unstable
Monitor blood pressure closely
Pay meticulous attention to good surgical
technique
Avoid nephrotoxic drugs
Adjust doses of drugs metabolized by the
kidney
UNDER CONSERVATIVE
CARE
15. If medical parameters permit
Try to eliminate all foci of infection
Keep only the easily maintainable teeth
Insist on keeping a good oral hygiene
If patient is in advance stages, dental care may
best be provided after physician’s consultation
and in a hospital like setting
16. Because of the potential for bleeding
problems:
1. Pretreatment screening for bleeding
time and platelet count
2. A hematocrit level and hemoglobin
count should be obtained to assess
the status of anemia
17. If an oro facial infection exists,
aggressive management is
necessary using culture and
sensitive tests and appropriate
antibiotics
22. Same as conservative care conditions
Beware of concerns of arteriovenous shunt
Consult with the physician about risk for
infective endocarditis
Avoid blood pressure cuff and IV medications
in arm with shunt
Avoid dental care on day of treatment; best
to treat on day after
Consider antimicrobial prophylaxis
PATIENT RECEIVING
DIALYSIS
23. Consider corticosteroid supplementation as
indicated
Assess status of liver function and presence
of opportunistic infection in these patients
because of increased risk for carrier state of
hepatitis B and C viruses and human
immunodeficiency virus
24. Infection in such patients is life –threatening
Before transplantation easily only maintained
teeth should be determined by dental team
approach
Teeth with furcation involvement, periodontal
abscesses, or extensive surgical requirements
should be extracted
RENAL TRANSPLANT
PATIENT
25. 1- Emergency treatment only for 1st 6 month
2-Prophylactic antibiotics according to AHA
recommendations
3- Erythromycin is contraindicated in patients on
cyclosporins
4-Cyclosporin causes gingival overgrowth
5-Immunosuppressed patient requires
supplemental corticosteroids
MANAGEMENT