Routine and emergency management guidelines for the dental patient with renal disease and kidney transplant part 1 Imran Saif Angela Adkins Victoria Kewley Alexander Woywodt Vanita Brookes Dental Update 2024 38:3, 707-709.
Authors
ImranSaif
MBBS, FCPS(Med), FCPS(Neph)
Consultant Nephrologist, Plymouth Hospitals NHS Trust, LTHTR, UK
The number of kidney patients is increasing in all developed countries, mainly due to the increase in patients with type II diabetes. These patients may be asked by their renal physician to attend their general dental practitioner for an oral review prior to undergoing further renal treatment.
Dental surgeons working in the primary care setting will be required to manage patients who are at various stages of renal support, whether pre-dialysis patients with chronic kidney disease (CKD), dialysis patients, and also those who have had a kidney or kidney and pancreas transplant. In addition, dental practitioners may be faced with having to deal with the emergency management of such patients attending their practices in acute pain.
Clinical Relevance: This paper aims to provide the general dental practitioner with the necessary knowledge to manage renal patients, and outlines the guidance regarding the criteria for referral, work up procedure and dental management of such patients.
Article
Kidneys filter the blood and, in so doing, remove the waste products of metabolism. It is important to appreciate the multiple functions that the kidneys normally carry out:1
Kidneys play a key role in eliminating the waste products of metabolism. They also remove most drugs and toxins. Blood levels of substances such as urea and creatinine can be used to assess the excretory functions of the kidneys. A better index of kidney function is achieved by calculating the eGFR (estimated Glomerular Filtration Rate). The normal value is 90–120 mL/min and lower values are used to classify the severity of kidney disease.
Early kidney dysfunction may be asymptomatic and, indeed, some patients only develop symptoms after significant damage has been done. Therefore, it is important to monitor urea and creatinine levels in high-risk patients, for example those with diabetes, hypertension, proteinuria, and recurrent urinary tract infections.
Kidneys are the major route of elimination for some drugs such as aminoglycosides and these can accumulate to toxic levels in patients with Chronic Kidney Disease (CKD).
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