Renal Disorders

Platelet dysfunction may occur in renal patients giving rise to a bleeding tendency.

Patients on haemodialysis may be heparinised. Dental treatment should be carried out on the day after dialysis. Renal condition is optimal at this time and the anticoagulant effect has stopped.

 

The arm with vascular access for dialysis (the surgically created arterio-venous fistula) should not be used for venepuncture by the dentist.

Patients who have had a kidney transplant may need corticosteroid cover, have a bleeding tendency if anticoagulated, may have gingival hyperplasia if taking cyclosporin and are prone to infection due to immunosuppression.

 

Diabetes and renal disorders

 

Diabetic nephropathy is a common cause of end-stage renal failure (ESRF)

 

Chronic Renal Failure

 

Chronic renal failure (CRF) occurs after progressive kidney damage and constitutes a low glomerular filtration rate persisting over a period of 3 months or more. The symptoms and signs vary depending on the degree of malfunction.

 

Clinical Features:

Cardiovascular                   Hypertension

                                       Congestive cardiac failure

                                       Atheroma

Gastrointestinal                 Anorexia, nausea, vomiting

                                       Peptic ulcer

Neurological                      Lassitude

                                       Headaches

                                       Tremor

                                       Sensory disturbances

Dermatological                  Itching

                                       Hyperpigmentation

Haematological/Immunological      

                                       Bleeding tendency

                                       Anaemia

                                       Susceptibility to infection

Metabolic (Uraemia)          Thirst

                                       Nocturia/polyuria

                                       Electrolyte disturbance

                                       Secondary hyperparathyroidism

                         

Ref: British Dental Journal 23 August 2003; Volume 195, No. 4

 

Bone disease or 'renal osteodystrophy' is an almost universal feature of CRF and may take one or a combination of forms.

 

 

 

Renal patients may have impaired drug excretion. Drugs used in dental sedation and general anaesthesia should be used with caution and in consultation with a physician.

Renal disease influences the use of other drugs in dentistry, particularly NSAIDS and some antimicrobials.

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Dialysis, transplantation  and nephritic syndrome