This document provides an overview of kidney anatomy, functions, and disorders. It discusses the normal kidney anatomy, major kidney functions including excretion and hormone regulation. Kidney disorders are classified as acute kidney injury, chronic kidney disease, and end-stage renal failure. Specific disorders like glomerulonephritis, nephritic syndrome, and nephrotic syndrome are explained. The document also reviews oral manifestations of chronic kidney disease and considerations for dental treatment of patients with renal disorders.

1. PRESENTED BY : Rajan Chaudhary
BDS 4th year
College of Medical Sciences-TH, Bharatpur
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2. CONTENTS:
1. Kidney-normal Anatomy
2. Major Functions Of The Kidneys
3. Disorders Of Kidney
4. Acute Kidney Injury
5. Chronic Kidney Disease
6. End-stage Renal Failure Or Uremic Syndrome
7. Glomerulonephritis
8. Nephritic Syndrome
9. Nephrotic Syndrome
10. Acute Pyelonephritis
11. Polycystic Renal Disease
12. Oral Manifestations In Chronic Renal Failure
13. Dental Considerations
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3. KIDNEY-Normal Anatomy
The human kidneys are bean-shaped organs located in the retroperitoneum at the level
of the waist.
The kidney’s functional unit is the nephron
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4. MAJOR FUNCTIONS OF THE KIDNEYS
• Non-excretory functions:
Degradation of polypeptide hormones
• Insulin
• Glucagon
• Parathormone
• Prolactin
• Growth hormone
• Antidiuretic hormone
• Gastrin
• Vasoactive intestinal polypeptide
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5. Synthesis and activation of hormones
• Erythropoietin (stimulates erythrocyte production by bone
marrow)
• Prostaglandins (vasodilators that act locally to prevent renal
ischemia)
• Renin (important in regulation of blood pressure)
• 1,25-Dihydroxyvitamin D3 (final hydroxylation of vitamin D to its
most potent form)
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6. •Excretory functions:
• Excretion of nitrogenous end products of protein metabolism (eg,
creatinine , uric acid, urea)
• Maintenance of ECF volume and blood pressure by altering Na+
excretion
• Maintenance of plasma electrolyte concentration within normal
range
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7. • Maintenance of plasma osmolality by altering water excretion
• Maintenance of plasma pH by eliminating excess H+ and
regenerating HCO3-
• Provision of route of excretion for most drugs
• NOTE:
• ECF = extracellular fluid; H+ = hydrogen;
• HCO3- = bicarbonate; Na+ = sodium; pH = hydrogen ion concentration
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8. DISORDERS OF KIDNEY
Disorders of the kidneys can be classified into the following
diseases or stages:
• Disorders of hydrogen ion concentration (pH) and electrolytes,
• Acute renal failure(ARF),
• Chronic renal failure (CRF), and
• End-stage renal failure or uremic syndrome.
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9. ACUTE KIDNEY INJURY (AKI)
• AKI is a clinical syndrome
characterized by a rapid decline
in kidney function over a period
of days to weeks, leading to
severe azotemia.
• Due to
• Prerenal Failure
• Postrenal Failure
• Acute Intrinsic Failure
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10. PRENAL FAILURE
The most common cause of AKI and hospital-acquired renal failure.
•Volume depletion
•Heart failure
•Cardiovascular shock
•Medications that perturb blood flow through the nephron
•Changes in fluid volume distribution that are associated with
sepsis and burns.
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11. POSTRENAL FAILURE
• Obstruction of the flow of urine from the kidneys at any level of the urinary tract
• Obstructive uropathy
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12. ACUTE INTRINSIC FAILURE
• Glomerular disease
Glomerulonephritis
• Vascular disease
Renal arterial or venous thromboses
• Tubulointerstitial disease (most common cause)
Interstitial nephritis and acute tubular necrosis
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13. CHRONIC KIDNEY DISEASE (CKD)
• GFR <90ml/min/1.73m2 in a period of ≥3
months
• Nephritic Syndrome
• Nephrotic Syndrome
• Pyelonephritis
• Polycystic Renal Disease
• Hypertensive Nephrosclerosis
• Connective Tissue Disorders ( SLE and
scleroderma or progressive systemic
sclerosis)
• Metabolic Disorder ( DM, amyloidosis,
gout, and primary HPTH)
• Toxic Nephropathy
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14. END-STAGE RENAL FAILURE OR UREMIC SYNDROME.
Etiology of End-Stage Renal Disease
• Disorder Percentage of New Dialysis Patients
• Diabetes mellitus
• Hypertension
• Glomerulonephritis
• Interstitial nephritis
• Pyelonephritis
• Polycystic kidney disease
• Other disorders
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15. GLOMERULONEPHRITIS
• Refers to that variety of kidney disease in which proliferation and inflammation of
the glomerulus is secondary to an immunologic mechanism.
• Presentation of GN varies from microscopic asymptomatic hematuria or
proteinuria to acute nephritis, to rapidly progressive nephritis.
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16. NEPHRITIC SYNDROME
• Hematuria – dysmorphic
red blood cells, red blood
cell casts
• Azotemia
• Oliguria
• Hypertension
• Variable proteinuria
(usually < 3 g/day)
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17. NEPHROTIC SYNDROME
• Proteinuria > 3.5 g/day/1.73 m2
• Hypoalbuminemia < 3.5 g/dL
• Edema
• Hyperlipidemia
• Lipiduria
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18. 7/10/2019 18

19. ACUTE PYELONEPHRITIS
• It is the inflammation of the
kidney & upper urinary tract
that usually results from the
bacterial infection of the
bladder.
• Acute onset of pain
• Fiver with chills
• Lumbar tenderness
• Dysuria
• Frequency of micturition
• On examination ,urine will
show bacteria in excess of
100,000/ml, pus cells .
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20. POLYCYSTIC RENAL DISEASE
• Polycystic kidney disease (PKD) is an inherited disorder in which clusters of cysts
develop primarily within kidneys, causing kidneys to enlarge and lose function
over time.
• Cysts are noncancerous round sacs containing fluid.
• Abdominal pain or tenderness
• An increase in the size of the abdomen
• Blood in the urine
• Flank pain on one or both sides
• Drowsiness
• High blood pressure
• Painful menstruation
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21. ORAL MANIFESTATIONS IN CHRONIC RENAL FAILURE
• Oral symptoms are observed in 90% of patients with renal disease
CLINICAL MANIFESTATIONS
• Odor of urea on breath
• Metallic taste
• Uremic stomatitis
• Enlarged (asymptomatic) salivary glands
• Decreased salivary flow
• Dry mouth
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22. •Low caries rate
•Dark brown stains on crowns
• Extrinsic (secondary to liquid ferrous sulfate therapy)
• Intrinsic (secondary to tetracycline staining)
•Enamel hypoplasia
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23. Enamel hypoplasia and tetracycline stains in
a young patient with end-stage renal disease
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24. • Pale mucosa with diminished color demarcation between attached
gingiva and alveolar mucosa
• Petechiae and ecchymosis
• Low-grade gingival inflammation
• Increased calculus formation
• Bleeding from gingiva
• Prolonged bleeding
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25. •Candidal infections
•Burning and tenderness of mucosa
•Erosive glossitis
•Tooth erosion (secondary to regurgitation associated with
dialysis)
•Dehiscence of wounds
•Tooth mobility
•Drifting
•Dental malocclusions
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26. RADIOGRAPHIC MANIFESTATIONS
• Renal Osteodystrophy or 20
HyperParathyroidism leading
to
• Demineralization of bone
• Loss of bony trabeculation
• Ground-glass appearance
Panoramic image showing trabecular changes.
Also note erupted lower third molars without fully
developed root formations.7/10/2019 26

27. Mandibular anterior loss of trabeculation.
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28. Maxillary anterior loss of trabeculation.
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29. Loss of lamina dura7/10/2019 29

30. •Giant cell lesions, “brown tumors”-small lytic lesions with
areas of old hemorrhage
•Root resorption
•Arterial and oral soft tissue calcifications
•Calcification and Pulpal narrowing
• Abnormal bone repair after extraction leading to deposition of sclerotic bone in
the confines of the lamina dura-Socket sclerosis
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31. Panoramic radiograph of extraction sites representative of socket sclerosis.
Teeth were extracted six years before the radiograph and two years before
diagnosis of end-stage renal disease.
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32. DENTAL CONSIDERATIONS
•Control of bleeding: hemostasis by desmopressin,
cryoprecipitate and conjugated estrogen
•Position of patient in dental treatment : legs and arms should
not be cramped to allow unimpeded blood flow, short duration
of dental treatment on dental chair
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33. •Infective endocarditis prevention: antibiotic porphylaxis like
amoxicillin 3g 1 hour before treatment followed by 500mg 8
hourly for 2-3 days.
•Candidial infection : nystatin mouthwash 5,000,000u/ml QID 1
day before the dental treatment and up to 2 days after
treatment .
•Medication to be avoided in dialysis patient: drugs excreted
through kidney are avoided like NSAIDs, tetracycline, steroids,
phenacetin, benzyl penicillin.
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34. CONCLUSION:
• A better understanding of the systemic and oral abnormalities in
individuals with renal disease will help dentists and oral healthcare
workers to render efficient oral care and plan preventive regimens
tailored to individual needs. With the increased availability and use of
dialysis, renal transplantation, and other advancements, many oral
manifestations of renal failure and uremia are observed less frequently.
However, as the signs and symptoms of renal disease can be observed
in the oral cavity, the dentist can play an important role in the
diagnosis and treatment of these patients. Early diagnosis and prompt
treatment of oral disease are mandatory and will minimize the need
for extensive dental care. Patients and guardians should be informed
about the role of oral hygiene in reducing the risks of oral infections,
septicemia, and endocarditis.
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35. REFERENCES
• Burket’s ORAL MEDICINE ,12th edition
• “Oral conditions in renal disorders and treatment considerations – A
review for pediatric dentist” Megha Gupta,Mridul Gupta,and
Abhishek- Saudi Dent J. 2015 Jul; 27(3): 113–119.
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36. THANKYOU!
HAVEA GOODDAY!!
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