CKD.docx

CHRONIC RENAL FAILURE Definitions represents a clinical state in which there is an irreversible loss of endogenous renal function, of a degree sufficient to render the patient permanently dependent upon renal replacement therapy (dialysis or transplantation) in order to avoid life-threatening uremia...

CHRONIC RENAL FAILURE Definitions represents a clinical state in which there is an irreversible loss of endogenous renal function, of a degree sufficient to render the patient permanently dependent upon renal replacement therapy (dialysis or transplantation) in order to avoid life-threatening uremia Uremia is the clinical syndrome, reflecting dysfunction of all organ systems as a result of untreated or undertreated acute or chronic renal failure. Risk Factors For CKD  Elderly,Male  Low birth wt.,Reduced nephron no. at birth.  Obesity.  Cigarette smoking.  Family history of kidney disease.  Diabetes mellitus,Hypertension.  Proteinuria,Dyslipidemia,Atherosclerosis.  Autoimmune dis.  Recurrent urinary tract infection .  Nephrotoxins : NSAIDS, Heavy metals,.. CLINICAL MANIFESTATIONS OF CRF  hyperkalemia  Metabolic Acidosis , hypocalcaemia , hyperphosphatemia, , and hypovitaminosis D, resulting in secondary hyperparathyroidism  Congestive Heart Failure  Hypertension  Pericarditis  Anemia of CKD, primarily due to decreased erythropoitin production, often becomes clinically significant during stage 3 CKD. CKD is also associated with high levels of hepcidin, which blocks GI iron absorption and mobilization of iron from body stores; this results in a functional iron deficiency  Tendency to abnormal bleeding and bruising  enhanced susceptibility to infection.  Anorexia, hiccoughs, nausea, and vomiting are common early manifestations of uremia. TREATMENT  Superimposed Factors uncontrolled hypertension, urinary tract infection, superimposed obstructive uropathy (e.g., due to stone disease), nephrotoxic medications (e.g., NSAIDs) and radiocontrast agents,  Dietary Protein Restriction  Preparation for Renal Replacement Therapy either dialysis or transplantation Indications of initiation renal replacement therapy:  neuropathy attributable to uremia,  encephalopathy,  muscle irritability,  Progressive anorexia and nausea  volume overload unresponsive to diuretic therapy,  hyperkalemia unresponsive to dietary potassium restriction  progressive metabolic acidosis that cannot be managed with alkali therapy Dental management of renal failure patients Consultation with the nephrologists provides information on the state of the disease, the type of treatment, the best timing of dental management, or the medical complications that may arise Any modification of the usual medication used by the patients or of other aspects of their treatment must first be consulted with the nephrologists Prior to any invasive dental treatment, a complete blood count is to be obtained, together with coagulation tests, in view of the possible hematological alterations It is essential to eliminate any infection in the oral cavity as soon as possible , with the consideration ofAntibiotic prophylaxis The metabolism and elimination of certain drugs are altered in situations of renal failure. In such cases dose adjustment or modification of the dosing frequency is needed . The prescription of aminoglycoside antibiotics and tetracyclines is to be avoided, because of theirnephrotoxicity . Penicillins, clindamycin and cephalosporins can be administered at the usual doses, and are the antibiotics of choice . As regards analgesics, paracetamol is the non-narcotic analgesic of choice in application to episodic pain. Aspirin possesses antiplatelet activity, and as such should be avoided in uremic patients As regards the rest of nonsteroidal antiinflammatory drugs (indomethacin, ibuprofen, naproxen and sodium diclofenac), dose reduction or even avoidance is indicated in the more advanced stages of renal failure Benzodiazepines can be prescribed without the need of dose adjustments, though excessive sedation may occur. Dialyzed patients Dialyzed patients are at an increased risk of bleeding. It is advisable to provide dental treatment on non-dialysis days, to ensure the absence of circulating heparin, which has a half-life of about four hours . In any case, prior to invasive procedures, it is important to request a complete blood count and coagulation tests , and to ensure that local hemostatic measures are available: mechanical compression, sutures , topical thrombin, microfibrilar collagen and oxidized regenerated cellulose. Dialyzed patients are subjected to numerous transfusions and blood exchanges, and this implies an increased risk of infection in the form of HIV, HBV, HCV and tuberculosis Transplant patients - It is important to conduct dental evaluation prior to renal transplantation, in order to eliminate the existing infectious foci. - The potential for oral infections after transplantation isvery high, since these patients receive immunosuppressive therapy. Also some immunosuppressive drugs may affect the teeth and the oral cavity requiring dental intervention .