Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Renal diseases
1. Oral Diagnosis-I
Review of chronic renal failure and dialysis
December 24, 2006
Dr. Suresh. C. S. BDS; MDS; MDSc (UK)
2. Chronic Renal Failure & Dialysis
“Overview”
Kidney regulate fluid volume and acid
base balance of the plasma
Excrete nitrogenous waste
Synthesize erythropoietin, 1,25-
dihydroxycholecalciferol & renin
Drug metabolism
They are the target organs for
parathormone & aldosterone
3. Chronic Renal Failure & Dialysis
Definition
End stage renal disease (ESRD) is a
bilateral progressive and chronic
deterioration of nephrons (the
functional unit of the kidney).
The disease results in uremia and can lead to death.
ESRD manifests when 50-75% of nephrons lose
function.
4. Chronic Renal Failure & Dialysis
Incidence & Prevalence
In US, 8 million people have some form of kidney
disease, 360,000 have irreversible ESRD.
Average dental practice of 2000 patients can expect
to have 2 patients with ESRD.
♂>♀.
Age: 45-65.
7. Chronic Renal Failure & Dialysis
Signs & Symptoms (Cont.)
Hyperpigmentation of the skin (retention of carotene-
like pigments normally excreted by the kidney)
Gastrointestinal signs:
Anorexia
Nausea
Vomiting
Generalized gastroenteritis
Peptic ulcer disease
8. Chronic Renal Failure & Dialysis
Signs & Symptoms (Cont.)
Stomatitis manifested by oral
ulceration & candidiasis.
Parotitis may be seen and a urine
like odor to the breath may be
detected.
Uremic syndrome commonly causes malnutrition and
diarrhea.
9. Chronic Renal Failure & Dialysis
Medical Management
The goals of treatment are to retard the progress of
disease and preserve the patient’s quality of life
A conservative approach
Involve decreasing the retention of nitrogenous
waste products
Controling hypertension, fluids & electrolyte
imbalances
Anemia associated with renal failure usually is
treated with the use of recombinant human
erythropoietin
10. Chronic Renal Failure & Dialysis
Medical Management (Cont.)
Dialysis
It is a medical procedure that artificially
filters blood
It becomes necessary when the number of nephrons
diminishes too much.
Every 2 or 3 days depending on need
Usually 3 to 4 hours are required for each session
11. Chronic Renal Failure & Dialysis
Medical Management (Cont.)
Drugs that are metabolized primarily
by the kidney should be avoided
Abnormal bleeding is associated with
dialysis
Bleeding tendency because of altered
platelets aggregation and decreased
platelets factor III
5 years survival rate is 28%
An alternative is renal transplantation
12. Chronic Renal Failure & Dialysis
Dental Management
Patients under conservative care
Consultation with patient’s physician
If patient is in advance stages, dental care may
best be provided after physician’s consultation
and in a hospital like setting.
Because of the potential for bleeding problems:
o Pretreatment screening for bleeding time and platelet
count.
o A hematocrit level and hemoglobin count should be
obtained to assess the status of anemia
13. Chronic Renal Failure & Dialysis
Dental Management (Cont.)
If an orofacial infection exists, aggressive
management is necessary using culture and
sensitive tests and appropriate antibiotics
Nephrotoxic drugs should be avoided
Example: NSAID, Aspirin, and Tetracycline
require special dosage adjustments
14. Chronic Renal Failure & Dialysis
Dental Management (Cont.)
Patients receiving dialysis
Patients are at risk for infective endocarditis but the
reason(s) are not yet fully established.
Infective endocarditis occurs in 2% to 9% of patients
receiving hemodialysis
40% of patients on dialysis have congestive heart
failure
Hemodialysis tends to aggravate bleeding tendencies
• Physical destruction of platelets
• Heparin usage
15. Chronic Renal Failure & Dialysis
Oral Complications & Manifestations
Pallor of the oral mucosa secondary to anemia
Red-Orange discoloration of the cheeks and
mucosa caused by pruritis and deposition of
carotene-like pigments
Diminished salivary flow (parotid infections)
Candidiasis (xerostomia)
16. Chronic Renal Failure & Dialysis
Oral Complications & Manifestations
(Cont.)
Patients complain of an altered metallic
tastes.
Uremic stomatitis.
Petechiae and ecchymosis on the labial
and buccal mucosa, soft palate and
margins of the tongue as well as gingival
bleeding.
Osseous changes of the jaws.