Renal Disease

Presented by Dieu Pham, Krista Prince, and

Kimberly Truong

Function of the Kidneys

Kidneys are the organs that help filter waste products from the
blood.

They are also involved in regulating blood pressure, electrolyte

balance, and red blood cell production in the body.

Healthy Kidneys:

Maintain a balance of water and concentration of minerals,

such as sodium, potassium, and phosphorus, in your blood

Remove waste by-products from the blood after digestion,

muscle activity, and exposure to chemicals or medications

Produce renin, an enzyme that helps regulate blood pressure

Produce erythropoietin, which stimulates red blood cell

production

2 types of Renal Disease

Acute kidney disease/failure: sudden onset of kidney
dysfunction wherethe kidneys fail tofilter out the toxins
and excess water that are created through the natural
process of metabolism. This results in the accumulation
of fluids, electrolytes, and metabolic waste products.
Chronic kidney disease/failure: when a disease slowly
and gradually destroys the filtering capacity of the
kidneys. As chronic renal insufficiency continues and
progresses, it may eventually reach the point where it is
considered to be end-stage renal disease (ESRD).
End-stage renal disease occurs if one or both kidneys fail
completely and the damage can't be reversed, this results in
total and permanent kidney failure

Etiology of Renal Disease

A traumatic injury with blood loss
The sudden reduction of blood flow to the
kidneys
Damage to the kidneys from shock during a
severe infection called sepsis
Obstruction of urine flow, such as with an
enlarged prostate
Damage from certain drugs or toxins
Pregnancy complications, such as eclampsia
and pre-eclampsia

Occurrence
The number of hospitalizations that included an AKI
diagnosis rose from 3,942 in 1996 to 23,052 in
2008.
The percentage of AKI diagnoses that required
dialysis declined from 13.39 in 1996 to 2.25 in
2008.
The incidence (# of new cases of a disease within a
given time period) of CKD is increasing most rapidly
in people ages 65 and older.
The prevalence (# of existing cases of a disease
within a given time period) of CKD is growing most
rapidly in people ages 60 and older.
ESRD incident rates are more than three times
higher for African Americans than for Caucasians.
At the end of 2009, more than 871,000 people were
being treated for ESRD.

Treatment
Treatment for acute and chronic kidney disease: involves
identifying the illness that damaged the kidney and controlling
the underlying cause through treatment to balance amount of
fluids in the blood, medication to control blood potassium and
calcium levels, and even dialysis to remove toxins from blood
Treatments for end-stage renal disease: dialysis or
transplantation.
Two major types of dialysis:
In hemodialysis, blood is run through an external filter and the clean
blood is returned to the body.
Hemodialysis is usually done at a dialysis center three times a week.
Peritoneal dialysis uses the lining of your abdominal cavity (the space
in your body that holds organs like the stomach, intestines, and liver)
to filter your blood.
This kind of dialysis is needed daily but it can be performed at home,
while you sleep.
A kidney transplant is an operation that places a healthy kidney in
your body. The transplanted kidney takes over the work of the two
kidneys that failed, and you no longer need dialysis.

Medications Used in
Treatment
Controlling blood pressure is also very
important for people with kidney disease.
Several types of medicine that help people
keep their blood pressure in a healthy range.
Two kinds of medicines:
ACEi (angiotensin converting enzyme
inhibitors)
ARBs (angiotensin receptor blockers) which
also help to protect the kidneys.

Indications for Dental

Treatment
Main concern: bleeding tendency; careful
hemostasis should be ensured if surgery is
necessary
Prophylactic antibiotics of amoxicillin before
dental procedure or clindamycin if allergic
Also premed required due to potential
complication of bacterial endocarditis in dialyzed
patients
Best carried out the day after dialysis
Local anesthesia is safe unless there is severe
bleeding tendency

Contraindications for
Dental Treatment
Patients should avoid any elective dental
treatment within first 6 months after
transplantation
Prescription of aminoglycoside and tetracycline
should be avoided in chronic renal failure due
to nephrotoxicity
Avoid aspirin (possess antiplatelet activity)
Avoid NSAIDs (ibuprofen, naproxen, and
indomethacin) generate a hypertensive effect

Impact on Oral Health

Ammonia-like taste and smell
Gingivitis
Loose teeth leading to tooth loss
Bone loss in the jaw
Dry mouth and decreased salivary flow result
in calculus accumulation

Effects of Medication on
Oral Health
Cyclosporine and calcium channel blockers
contribute to gingival hyperplasia, which is
exacerbated by poor oral hygiene

Periodontal Management
Consultation with physician to provide information on the state of the
disease and the best timing of dental treatment
Close cooperation between medical and dental professional is desirable to
improve oral and general health of patient
Complete blood count should be obtained, together with coagulation tests
Essential to eliminate any infection in the oral cavity as soon as possible
with consideration of antibiotic prophylaxis when bleeding
For transplant patient: meticulous pretransplant dental care; high risk for
local infection related to dentition once they take immunosuppressive
meds; can compromise transplanted organ
Frequent dentist visit for calculus removal and reduce risk or oral infection
because they form more rapidly
Monitor blood pressure before and during treatment with admin. Of
sedation to lessen anxiety

Dental Hygiene Considerations

Short appointments
Recall: 6 months
Semi-supine chair position
Medical consultation may be necessary
Ultrasonic use is contraindicated
Best time for treatment is day after dialysis
Pre-med not usually recommended

Review Question no. 1

Review Question no. 2

Review Question no. 3

True or False: The best time to treat a
patient with kidney failure is the day
after dialysis. Ultrasonic use is
contraindicated for renal disease
patients.
Both statements are true.
The first statement is true and the second
statement is false.
Both statements are false.
The first statement is false and the second
statement is true.

Answers

1.
2.
3. Correct answer: A

References
"Dental Health for People with Kidney Disease." - DaVita.
N.p., n.d. Web. 29 Nov. 2014.
"National Kidney and Urologic DiseasesInformation
Clearinghouse
(NKUDIC)." Kidney Diseases Statistics
for the United States. N.p., n.d. Web. 29 Nov. 2014.
"Acute Kidney Failure." Treatments and Drugs. N.p., n.d.
Web. 29 Nov. 2014.
"National Kidney and Urologic DiseasesInformation
Clearinghouse
(NKUDIC)." Kidney Diseases Statistics
for the United States. N.p., n.d. Web. 29 Nov. 2014.
"Kidney Disease: Early Detection and Treatment." U.S
National Library of
Medicine. U.S. National Library of
Medicine, n.d. Web. 29 Nov. 2014.