Term
| What can progressive kidney disease lead to? |
|
Definition
| reduced renal function, with effects on multiple organ systems |
|
|
Term
| What are some Potential manifestations? |
|
Definition
| anemia, abnormal bleeding, electrolyte and fluid imbalance, hypertension, drug intolerance, and skeletal abnormalities that can affect the delivery of dental care |
|
|
Term
| What is chronic kidney disease(CKD)? |
|
Definition
| a progressive loss of renal function that persists for 3 months or longer, results from direct damage to nephrons |
|
|
Term
|
Definition
-uremia
-kidney failure
-death |
|
|
Term
| What are the stages of CKD based on? |
|
Definition
| a five–stage classification system for CKD based on the glomerular filtration rate (GFR) |
|
|
Term
|
Definition
| characterized by normal or only slightly increased GFR associated with some degree of kidney damage |
|
|
Term
|
Definition
| is marked by a mildly decreased GFR |
|
|
Term
|
Definition
| is evidenced as a moderately decreased GFR, with loss of 50% or more of normal renal function |
|
|
Term
|
Definition
| defined by a severely decreased GFR |
|
|
Term
|
Definition
| reflected by renal failure, wherein 75% of more of the approximately 2 million nephrons have lost functi |
|
|
Term
| What happens in stages 2-5? |
|
Definition
| nitrogen products accumulate in the blood, and the kidneys perform fewer excretory, endocrine, and metabolic functions, with eventual loss of the ability to maintain normal homeostasis |
|
|
Term
| Are stages 1-3 symptomatic? |
|
Definition
| no, tend to be asymptomatic |
|
|
Term
| What is end stage renal disease(ESRD) caused by? |
|
Definition
| conditions that destroy nephrons |
|
|
Term
| What are the 4 most common causes of ESRD? |
|
Definition
1.diabetes mellitus (37%) 2.hypertension (24%)
3.chronic glomerulonephritis (16%) 4.polycystic kidney disease (4.5%) |
|
|
Term
| What are the underlying pathologic processes for renal failure? |
|
Definition
| Deterioration and destruction of functioning nephrons |
|
|
Term
| Normal function is maintained until how many of the nephrons re destroyed? |
|
Definition
|
|
Term
| Will someone with early renal failure have symptoms? |
|
Definition
|
|
Term
| Patients with advanced renal disease develop what? |
|
Definition
| uremia, which is uniformly fatal if not treated(drop in urine output, this can cause hypertension from fluid retention) |
|
|
Term
|
Definition
The buildup of nonprotein nitrogen compounds in the blood, mainly urea, as a consequence of loss of glomerular function
-measured as blood urea nitrogen(BUN) |
|
|
Term
|
Definition
| acidosis which can cause sepsis |
|
|
Term
| What are some hematologic abnormalities that people with ESRD exhibit? |
|
Definition
| anemia, leukocyte and platelet dysfunction, and coagulopathy |
|
|
Term
| What is host defense compromised by? |
|
Definition
| nutritional deficiencies, leukocyte dysfunction, depressed cellular immunity, and hypogammaglobulinemia |
|
|
Term
| What is Hemorrhagic diatheses characterized by? |
|
Definition
tendency toward abnormal bleeding and bruising
-common with ESRD |
|
|
Term
| What is the cardiovascular system is affected by with ESRD? |
|
Definition
| athero- and arteriosclerosis and arterial hypertension, the latter due to sodium chloride (NaCl) retention, fluid overload, and inappropriately high renin levels |
|
|
Term
| What is renal osteodystrophy? |
|
Definition
| variety of bone disorders seen with ESRD |
|
|
Term
| What are the symptoms seen after stage 3 of CKD? |
|
Definition
-general ill feeling, fatigue, headaches, nausea, loss of appetite, and weight loss
-With further progression, anemia, leg cramps, insomnia, and nocturia often develop
-The anemia produces pallor of the skin and mucous membranes and contributes to the symptoms of lethargy and dizziness |
|
|
Term
| Hyperpigmentation of the skin is characterized by... |
|
Definition
| a brownish-yellow appearance, caused by the retention of carotene-like pigments normally excreted by the kidney |
|
|
Term
|
Definition
| a whitish coating on the skin of the trunk and arms, produced by residual urea crystals left when perspiration evaporates |
|
|
Term
| What tests are used to monitor disease progress? |
|
Definition
| GFR, urinalysis, BUN, serum creatinine, creatinine clearance, electrolyte measurements, and protein electrophoresis |
|
|
Term
| What is the most basic test of kidney function? |
|
Definition
|
|
Term
| What is the principal marker of kidney damage? |
|
Definition
| persistant protein in urine |
|
|
Term
| The serum creatinine level is a measure of... |
|
Definition
| muscle breakdown and filtration capacity of the nephron |
|
|
Term
| The patient with renal failure remains asymptomatic until... |
|
Definition
| the GFR drops to below 20 mL/minute, the creatinine clearance drops to below 20 mL/minute, and the BUN is above 20 mg/dL |
|
|
Term
| What does conservative care involve? |
|
Definition
| decreasing the retention of nitrogenous waste products and controlling hypertension, fluids, and electrolyte imbalances (dietary modifications) |
|
|
Term
| What are corrected or controlled during the earliest stage possible? |
|
Definition
| Comorbid conditions, such as diabetes, hypertension, congestive heart failure, and hyperparathyroidism |
|
|
Term
| When are Anemia, malnutrition, and bone disease (e.g., hyperparathyroidism) typically managed? |
|
Definition
|
|
Term
| What happens in stage 4? 5? |
|
Definition
4-care by a nephrologist is recommended, and preparations for renal replacement therapy begin
5-dialysis is started |
|
|
Term
| What are the two types of peritoneal dialysis? |
|
Definition
-continuous cyclic peritoneal dialysis (CCPD)
-chronic ambulatory peritoneal dialysis (CAPD) |
|
|
Term
|
Definition
| also known as automated peritoneal dialysis (APD), uses a machine to perform three to five dialysate exchanges while the patient sleeps |
|
|
Term
|
Definition
| exchanges are performed manually |
|
|
Term
| What are the advantages of peritoneal dialysis? |
|
Definition
| relatively low initial cost, ease of performance, reduced likelihood of infectious disease transmission, and absence of requirement for anticoagulation |
|
|
Term
| Who is periteral dialysis mainly used on? |
|
Definition
| in patients in acute renal failure or in those who require only occasional dialysis |
|
|
Term
| What type of dialysis do most patients recieve? |
|
Definition
|
|
Term
|
Definition
-Treatments are performed every 2 or 3 days, and usually 3 to 4 hours is required for each session
-a permanent and surgically created arteriovenous graft or fistula, usually placed in the forearm
-Patients are “plugged in” to the hemodialysis machine at the fistula or graft site, and blood is passed through the machine, filtered, and returned to the patient |
|
|
Term
| What is typically administered during hemodialysis to precent clotting? |
|
Definition
|
|
Term
| Dialysis provides what percent renal function? |
|
Definition
|
|
Term
| What are those who revieve dialysis at risk for? |
|
Definition
| of hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) infections |
|
|
Term
| What can happen to the arteriovenous fistula? |
|
Definition
| can beome infected with something like staph auerus |
|
|
Term
| Patients with ESRD have bleeding caused by a decrease in which type of platelet? |
|
Definition
|
|
Term
| What is an alternative of dialysis? |
|
Definition
|
|
Term
| Patients with diabetes and hypertension should be screened for what? |
|
Definition
|
|
Term
| When is med con suggested? |
|
Definition
|
|
Term
| What should be closly monitored during and before the procedure? |
|
Definition
|
|
Term
| Large doses of corticosteriods may lead to what? |
|
Definition
|
|
Term
| main concern for ESRD is? |
|
Definition
| toxic effects on kidney from medications due to dental problems |
|
|
Term
| What are some ways that drugs can be effected with ESRD? |
|
Definition
-A low serum albumin value reduces the number of binding sites for circulating drugs, thereby enhancing drug effects
-Uremia can modify hepatic metabolism of drugs (increasing or decreasing clearance)
-Antacids can affect acid-base of electrolyte balance
-Larger initial doses may be required in the presence of substantial edema or ascites, whereas smaller initial doses may be required if dehydration or severe debilitation is present
-Aspirin and other NSAIDs potentiate uremic platelet defects |
|
|
Term
| What should be measured before intravenous sedation to ensure adequate oxygenation? |
|
Definition
| Although nitrous oxide and diazepam are antianxiety agents that require little modification for use in patients with ESRD, the hematocrit or hemoglobin concentration should be measured |
|
|
Term
| Why are drugs that supress the CNS best avoided in the presence of uremia? |
|
Definition
| uremia because the blood-brain barrier may not be intact, excessive sedation may result |
|
|
Term
| What is a common oral sign of chronic renal failure? |
|
Definition
| pallor of the oral mucosa related to anemia |
|
|
Term
| What may be present in severe renal failure? |
|
Definition
| uremic stomatitis may be present |
|
|
Term
| What are some oral lesions seen with chronic renal failure? |
|
Definition
-Oral mucosa lesions, including ulcers, lichen planus or lichenoid-like lesions
-hairy tongue
-hairy leukoplakia
-pyogenic granulomas |
|
|
Term
| May some tooth specific changes be seen with ESRD as well? |
|
Definition
| yes such as enamel hypoplasia |
|
|
Term
| What else may accompany chronic renal failure? |
|
Definition
Specific osseous changes of the jaws
-The most classically described osseous change is the triad of loss of lamina dura, demineralized bone (resulting in a “ground glass” appearance), and localized radiolucent jaw lesions (central giant cell granulomas also called brown tumors), the last from secondary hyperparathyroidism |
|
|
Term
| CCB's and cyclosporine and pheytoin may cause what? |
|
Definition
|
|
Term
| Peritoneal dialysis presents... |
|
Definition
| no additional problems in dental management |
|
|
Term
| What may the fistula for hemodialysis cause? |
|
Definition
|
|
Term
| What conditions are common in patients receiving dialysis? |
|
Definition
| Comorbid conditions such as cardiovascular disease and diabetes |
|
|
Term
| treatment modifications need to be used in dialysis patients to avoid what? |
|
Definition
|
|
Term
| Patients dependent on long term dialysis are prone to what? |
|
Definition
|
|
Term
| What may dialysis to do drugs? |
|
Definition
| shorten their effect because it cleans them out |
|
|
Term
| Hemodialysis reverses what? |
|
Definition
| many of the severe oral pathologic changes associated with ESRD |
|
|
Term
| Patients with a transplanted kidney may have what? |
|
Definition
| special management needs, including the need for corticosteroids or antibiotic prophylaxis and the need for management of oral infection and gingival overgrowth caused by cyclosporine therapy |
|
|
