The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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2. INTRODUCTION
functional units called NEPHRONS
Composed Of A Glomerule And Tubule.
Interconnected Capillaries Contained
Within A Cup-like Sac Bowman’s Capsule
Proximal Convoluted Tubule-loop Of Henle-distal
Convoluted Tubule-collector Duct
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3. FUNCTIONS
Excretion of metabolic waste products.
Electrolyte regulation
Endocrine regulatory functions
Metabolic functions
Control of blood pressure
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5. CLASSIFICATION
Acute Renal Failure (ARF)
sudden and important reduction in Glomerular
Filtration Rate (GFR) lasting for hours or days
Causes
pre-renal
intrinsically renal
post-renal
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6. PRE RENAL INTRINSIC POST RENAL
Gastrointestinal losses Acute tubular necrosis Urethral obstruction
Cardiovascular failure Severe cortical
necrosis
Bladder obstruction
Liver failure Severe acute
glomerulonephritis
Bladder rupture
Burns with fluid
sequestration
Vasculitis Bilateral ureteral
obstruction
Bleeding Malignant hypertension
Excessive perspiration Allergic interstitial
nephritis
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7. CHRONIC RENAL FAILURE
Gradual reduction in the number of functional nephrons
terminal or end-stage renal failure (ESRF)
Causes
Chronic immune glomerulopathy
Hypertensive nephrosclerosis
Chronic tubulointerstitial diseases
Metabolic diseases (e.g., diabetes mellitus)
Congenital and hereditary renal processes (e.g., renal polycystic
disease)
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8. Chronic renal failure
Glomerular Filtration Rate -<60
ml/min/1.73 m2
Micro- Or Macroalbuminuria
Persistent Hematuria
Radiological Anomalies
Period Of More Than Three Months
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9. Uremia
increased levels of acute phase proteins, certain
cytokines, and even macrophages.
Endocrine Functions Impaired
Extra-renal Multiorgan Disease
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10. Men
Most Frequent Causes
diabetes mellitus( 40-60% )
arterial hypertension(15-30%)
Glomerulonephritis(10%)
renal polycystosis(2-3%)
E.S.R.F.
hyperfunction of the remaining functional nephrons
systemic and intra-renal hypertension
proteinuria,
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12. CLINICAL MANIFESTATIONS
Generalized Paleness
Brown Hyperpigmentation Of The Nails And Skin
Retention Of Dietary Pigments
Skin Excoriations Produced By Intense Generalized Itching
Accumulation Of Calcium And Phosphate Microcrystals
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16. Susceptibility to infection
Decrease in cellular immune function
Chemotactic defects induced by uremia
Second most common reason for death
alterations in mineral metabolism
Renal osteodystrophy,
Skeletal defects
fractures, pain
joint and periarticular calcifications
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18. Oral manifestations
Bad odour
Metallic Taste
increased concentration of urea in saliva
and its posterior transformation into
ammonium
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19. xerostomia
Restriction In Fluid Intake
Side Effects Of Drugs
Possible Salivary Gland Alteration
Oral Breathing Secondary To Lung Perfusion
Problems
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20. Uremic stomatitis
Four Types
erythemo-pultaceous,
ulcerative
Hemorrhagic
Hyperkeratotic
painful
ventral surface of the tongue and on the anterior mucosal surfaces
resistant to treatment-blood urea levels remain high
Heal spontaneously within 2-3 week
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21. Gingival bleeding and inflammation
Petechiae and ecchymosis
platelet dysfunction
Effects of anticoagulants
Hyperplasia
secondary to drug treatment
Cyclosporine,calcium channel blockers
labial surface of the interdental papilla,
gingival margins and lingual and palatal surfaces
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22. Periodontal problem
attachment loss
deep pockets
Enamel hypoplasia
alterations in calcium and phosphorus metabolism
affect primary and permanent dentition
Severe erosions on the lingual surfaces of the teeth
frequent regurgitation and vomiting induced by uremia
Medication
Nausea associated to dialysis
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23. Pulp obliteration
Delays or alterations in eruption
Changes in maxillary bone
increased risk of fracture during extractions
Tooth mobility
Malocclusion
crowding,
pulp chamber calcifications
Temporomandibular joint problems
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24. A diminished prevalence of caries
protective effect on the part of urea
which inhibits bacterial growth
neutralizes bacterial plaque acids
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26. Mucosal lesions
Lichenoid reactions
Oral hairy leukoplakia
medication
drug-induced immune suppression
Malignancy
increased susceptibility to epithelial dysplasia and
carcinoma of the lip
iatrogenic immune suppression
Kaposi’s sarcoma or non-Hodgkin lymphoma
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27. Conservative
prevent or correct the metabolic alterations
Preserve the remaining renal functional capacity.
high carbohydrate and low protein diet
body weight control
treatment with antihypertensive drugs,lipid
lowering agents
vitamin D supplements
correction of the anemia with erythropoietin
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28. Dialysis and renal
transplantation
Artificial Mechanism That Clears Blood
Of Nitrogen Waste And Other Toxic
Products Of Metabolism
Two modalities
Peritoneal dialysis (PD)
hemodialysis (HD)
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29. PERITONIAL
Access to the body is gained through a
catheter placed in the abdominal wall and
inserted in the peritoneum.
The dialysate (sterile electrolyte solution) is
introduced through the catheter
peritoneal membrane filters the blood
waste products via an osmotic mechanism
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30. blood filtration is carried out by a machine (dialyzer)
equipped with a semipermeable membrane
allows passage of the excess fluids and waste
products
three days a week
an artificial permanent vascular access is placed in
the form of a catheter or surgically performed
arteriovenous fistula
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31. Heparin
To facilitate blood cycling through the dialyzer,
Measuring permeability of the vascular access.
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33. Renal transplantation
Treatment of choice in patients with irreversible
renal failure
Immunosuppressive therapy must be provided
to avoid acute rejection
All transplant patients, with the exception
identical twin, require life-long
immunosuppressive therapy
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34. Prevention of infections
Vaccination
Prognosis
prognosis of individuals with diabetes mellitus and/or
hypertension is poorer
Most common causes of death
cardiovascular problems (about 50% of global
mortality)
infections
malignization
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35. Dental Management
Consultation with the Nephrologist
State of the disease
Type of treatment
Best timing of dental management
Medical complications that may arise
Any modification of the usual medication used
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36. Multidiscipline approach
Complete blood count, together with coagulation
tests
Eliminate any infection in the oral cavity as soon as
possible
Antibiotic prophylaxis
Blood pressure is to be monitored
Administration of sedation
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37. Drugs
Aminoglycoside and tetracyclines is to be avoided,
Nephrotoxicity
Penicillins, clindamycin and cephalosporins
antibiotics of choice
Paracetamol
Analgesics
Avoid aspirin
Benzodiazepines can be used
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39. On Dialysed Patients..
Provide Dental treatment on non-dialysis days,
To ensure the absence of circulating heparin, which has a half-
life of about four hours
To prevent increased risk of bleeding
Complete blood count and coagulation tests
Local haemostatic measures
Mechanical compression,
Sutures
Tranexamic acid - or administered via the oral route at a dose
of 10-15 mg/kg body weight a day distributed in 2-3 doses
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40. Antibiotic coverage
2 g of amoxicillin via the oral route one hour
before the dental procedure.
Clindamycin 600 mg via the oral route, one hour
before the intervention
Protection against transfusion infections
Universal precautions
vaccinations
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41. On transplant patients…
Conduct dental evaluation prior to renal transplantation
To eliminate the existing infectious foci.
Teeth offering an uncertain prognosis are to be removed
Prophylactic antibiotic treatment
supplementary dose of corticosteroids
Stress
25 mg of hydrocortisone via the intravenous route, before the
intervention
Avoid elective dental treatment-6 months
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