CAITLIN MCFARLAND JENNIFER SEEGERS RICKY TURNER RENAL DISEASE CAITLIN MCFARLAND JENNIFER SEEGERS RICKY TURNER

STRUCTURE AND FUNCTION OF THE KIDNEY Paired, bean shaped organ Filter sodium and potassium ions from the blood and help to reabsorb these substances to maintain normal composition of body fluids. Substances that are not needed are are passed through urine. JENNIFER

WHAT IS RENAL DISEASE? General term for any damage that reduces the functioning of the kidney Leading causes are diabetes, high blood pressure, inherited disease, and infection. Symptoms of disease include; nausea, vomiting, decreased or increased urination, swelling of ankles, puffiness around the eyes, fetid breathe, fatigue, shortness of breathe, loss of appetite, high blood pressure, leg cramps, pale skin, dry/itchy skin. Acute and Chronic forms of disease The high blood pressure causes damage to the thin membranes in the kidneys. These are only 1 cell thick so high blood pressure can cause damage to the kidneys easily. Mrs Brown said not to go to far in detail with this topic JENNIFER

ACUTE RENAL FAILURE Rapid decline in renal function Caused by: drop in blood flow to kidneys, damage from meds, or blockage that stops urine Reversible if recognized early and if the contributing factors can be corrected More often in older people Most common indicator if it is azotemia (accumulation of nitrogenous waste in the blood) CAITLIN One form of renal disease is ACUTE RENAL FAILURE which is a rapid decline in renal function. It can be caused by drop in blood flow to kidneys, damage from medications, or blockage that stops urine from flowing out of the kidneys. If recognized early and if the contributing factors can be corrected it can be reversible. It is more often in older people. The most common indicator of this is AZOTEMIA which is an accumulation of nitrogenous waste in the blood. Other symptoms can be little or no urine during urination and flank pain which is pain in your back below your rib cage.

CHRONIC RENAL FAILURE Irreversible destruction 1 in 9 adults have chronic renal failure Greater risk in African Americans Complication: cardiovascular disease, anemia, or pericarditis Differentiated from AKD in that reduction of kidney function must be present for over 3 months CAITLIN Another form of renal disease is CHRONIC RENAL FAILURE which is an irreversible destruction of kidney function that occurs slowly over time. In the early stages there may be no symptoms. 1 in 9 adults have chronic renal failure. Most commonly caused by diabetes and or hypertension. African Americans are at greater risk due to there increased prevalence of hypertension. Complications associated with this disease is cardiovascular disease, anemia, or pericarditis. It is differentiated from acute kidney disease in that the reduction in kidney function must be present for over 3 months.

END STAGE RENAL DISEASE The last stage of chronic renal disease Complete kidney failure Dialysis or kidney transplantation is the only treatment for this condition Leads to death if you do not have dialysis or a kidney transplant CAITLIN The last stage of chronic renal failure is called END STAGE RENAL DISEASE. This is when there is complete failure of the kidney. The only treatment for this condition is Dialysis or kidney transplantation. If not treated will lead to death.

DIALYSIS Used when kidneys do not function properly Removes harmful substances from blood when the kidney cannot 2 types: hemodialysis & peritoneal CAITLIN When your kidneys fail, you need treatment to replace the work your kidneys used to do. Unless you have a kidney transplant, you will need a treatment called DIALYSIS. Dialysis removes harmful substances from blood when the kidneys cannot. During hemodialysis blood passes from the patient's body through a filter in dialysis machine. For this procedure, the patient has a specialized plastic tube placed between an artery and a vein in the arm or leg. During peritoneal dialysis, A plastic tube called a "dialysis catheter" is placed through the abdominal wall into the abdominal cavity. A special fluid is then flushed into the abdominal cavity and washes around the intestines. The intestinal walls act as a filter between this fluid and the blood stream.

TREATMENT Dialysis for kidney failure ACE inhibitors ARB (angiotensin II receptor blocker) Diet- lower amounts of sodium, phosphorus, potassium, and protein May need extra vitamin D to increase calcium absorption Exercise Use caution with alcohol, tobacco, illegal drugs and make sure your doctor knows what medications, over the counter, prescription and herbal that you are taking. RICKY

DENTAL CONCERNS Bad tastes in mouth Halitosis At risk for losing bone from their jaw Abnormalities in PMN Enamel hypoplasia This occurs because the kidneys fail to remove urea from the blood. The urea breaks down to form ammonia, which has a foul smell. Bone changes also can occur because the body cannot absorb calcium properly. Therefore, people with kidney disease are at risk for losing bone from their jaws. Their teeth may become loose and eventually fall out. Consider treatment for halitosis to help the patient regain some type of normality. Fluoride treatment to help with the enamel hypoplasia. Consider vitamin D supplements to help combat the risk for losing bone from their jaw. Consider gum with xylitol for the bad taste in the patients mouth and for the anti cariogenic effects of xylitol. (caution about the over ingestion of xylitol to quickly. Ok good you can explain this slide!!!!!!!!!!!!! RICKY

INDICATIONS FOR DENTAL TREATMENT Aggressive treatment prior to transplant Restorations, removal of non vital teeth, and prophylaxis RICKY

CONTRAINDICATIONS FOR DENTAL TREATMENT Wait 6 months after transplant for elective treatment Wait to do treatment day after dialysis for no heparin in the blood stream RICKY

PERIODONTAL MANAGEMENT Cyclosporine, expect gingival hyperplasia Weakened immune system http://www.dentistrytoday.com/periodontics/1591 If patient is on cyclosporine to help the body from rejecting the transplant, expect gingival hyperplasia and a weakened immune system, Also be cautioned about other infections the patient may be exposed to because of the weakened immune system. Might want to add the dental considerations and stuff from our drug books. (drug card here) JENNIFER

TREATMENT MODIFICATIONS Pre-Med antibiotic prophylaxis 6 months after kidney transplant 3 months recall Best time for dental treatment is the day after dialysis treatment Don’t take blood pressure on same arm with the shunt If you have a shunt, you may be given a blood thinner, which can increase the risk of bleeding. Because of the shunt, you may be at higher risk for certain infections. For this reason, your doctor may prescribe antibiotics for you to take before dental treatment. Depending on where the shut is drained to. If in the heart then pre-med is needed. If it is in the stomach, then pre meds are not needed. Ask your patient. The blood pressure cuff should not be placed on the arm with the shunt. Your blood pressure should be taken on the other arm, or on a leg. 3 months recall because of weakened immune system JENNIFER

Cont. Consult with nephrologist - may need pre-meds Obtain a complete blood count before treatment Monitor blood pressure Avoid NSAIDS – if on cyclosporine might cause renal toxicity CAITLIN Consulting with the nephrologist may be needed to determine if pre-med is necessary. This might require a complete blood count before treatment. You would need to monitor blood pressure. You need to monitor blood pressure. If patient is on cyclosporine you would need to advise patients to avoid the uses of NSAIDS because it might cause renal toxicity.

ANY QUESTIONS

QUESTION Dialysis is given to a patient that has no renal failure. True False FALSE

QUESTION There is no treatment modifications necessary for renal disease patient. True False FALSE

QUESTION Cyclosporine can result in gingival hyperplasia, and is has no side effects when taken with NSAIDS. Both statements are true Both statements are false The first statement is true, the second statement is false. The first statement is false, the second statement is true. TRUE, FALSE

REFERENCES http://medical-dictionary.thefreedictionary.com/Kidney+Disease http://nkdep.nih.gov/learn/are-you-at-risk/race-ethnicity.shtml http://www.scribd.com/doc/96752875/Renal-Diseases-Disorders http://www.cdeworld.com/courses/4478-Laboratory_Evaluation_of_Chronic_Medical_Conditions_for_Dental_Treatment--Part_II-Diabetes_and_renal_function http://www.medicinaoral.com/pubmed/medoralv13_i7_p419.pdf http://www.dentistrytoday.com/periodontics/1591 Porth, Carol. Essentials of Pathophysiology: Concepts of Altered Health States. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2007. Print. 28 HANDOUTS 6 TO A PAGE 4 TO A PAGE BROWN 1 NOTE PAGE PRINT 3