|
Dialysis, Renal Transplant and Nephrotic Syndrome |
Dialysis
¨ It is worth asking which type of dialysis a patient undergoes and when the last session was since patients are best treated when they have recently dialysed. ¨ Haemodialysis may be carried out in the body (peritoneal) or outside (extra-corporeal). ¨ It is important to consider the use of prophylactic antibiotics for any dental procedure that may cause a bacteraemia. ¨ Dialysis itself still carries a risk of infection (HIV, hepatitis, and bacterial) and this should be borne in mind.
Renal Transplant
¨ Infections tend to be poorly controlled in a patient with CRF and post-kidney transplant patients are immunosuppressed to prevent rejection. ¨ Transplant patients have an overall mortality of less than 5% and steroids will be used as part of the immunosuppression as well as other agents, usually cyclosporin. Antibiotic cover should be considered for at least two years post transplant. ¨ Patients may give a history of oral candidosis or oral viral infections e.g. herpes simplex, ¨ There is an increased chance of malignancy due to immunosuppression and these include basal cell and squamous cell cancers.
Nephrotic Syndrome
¨ Comprises proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia. ¨ Causes include diabetes mellitus and systemic lupus erythematosus. ¨ An increase in the level of circulating factor VIII leads to hypercoagulability and the possibility of thromboses. As a result such patients may give a history of taking prophylactic heparin. ¨ A patient with nephrotic syndrome may also be taking corticosteroids and using a low salt and high protein diet. ¨ Prophylactic antibiotics may be given for procedures likely to cause a bacteraemia. ¨ There is an increased likelihood of atheroma in these patients.
¨ Kidney stones are of little relevance to dental practice, except for the fact that they may be associated with hyperparathyroidism.
Ref: British Dental Journal 23 August 2003; Volume 195, No. 4
|
