Summary of CHRONIC KIDNEY DISEASE

Summary of Scientific Concepts and Discoveries in Chronic Kidney Disease (CKD)

• Definition and Nature of CKD:

  Chronic Kidney Disease (CKD) is a progressive reduction in kidney function over months or years, primarily due to a decrease in the number of nephrons, the functional units of the kidneys.

• Glomerular Filtration Rate (GFR):

  GFR is a critical indicator of kidney function. Normal GFR is approximately 130 ml/min/1.73 m². CKD is defined by a GFR of less than 90 ml/min/1.73 m² for three or more months, often accompanied by proteinuria or hematuria.

• Nephron Structure:

  The nephron consists of several components: Bowman's capsule, proximal convoluted tubule, loop of Henle, distal convoluted tubule, and collecting ducts.

• Kidney Functions:
  • Fluid and electrolyte balance
  • Metabolic waste removal
  • Acid-base balance
  • Vitamin D Metabolism
  • Stimulation of erythrocyte production through erythropoietin
• Acid-Base Balance Mechanisms:

  The kidneys maintain pH balance through bicarbonate reabsorption and hydrogen ion secretion, primarily in the proximal and distal convoluted tubules.

• Renin-Angiotensin-Aldosterone System (RAAS):

  Renin is released from juxtaglomerular cells in response to low blood pressure or sodium levels, leading to the production of angiotensin II, which regulates blood pressure and fluid balance.

• Vitamin D Metabolism:

  Vitamin D is activated in the kidneys to its biologically active form, which regulates calcium and phosphorus absorption.

• Types and Stages of CKD:

  CKD can be classified into various types based on etiology: vascular, glomerular, tubular, interstitial, and obstructive. Staging of CKD is based on GFR levels, ranging from early CKD (GFR > 90) to end-stage renal disease (GFR < 15).

• Systemic Effects of CKD:

  CKD affects multiple body systems, leading to symptoms such as anemia, hypertension, gastrointestinal issues, and neuromuscular disturbances.

• Dental Management Considerations:
  • Importance of thorough medical history and examination.
  • High risk of infections necessitates careful dental assessments.
  • Drug management is crucial, with specific recommendations on which drugs to avoid or adjust in dosage based on CKD severity.
  • Timing of dental treatments around dialysis schedules is essential to minimize complications.
• Post-Transplant Considerations:

  Management of dental care pre- and post-kidney transplant patients requires special attention due to their immunocompromised state and medication regimens.

Methodology for Dental Management in CKD Patients

• Initial Assessment:
  • Conduct thorough medical history and examination.
  • Identify etiology and degree of CKD.
• Dental Treatment Protocols:
  • Stages 1-3: Most dental treatments can proceed with caution regarding nephrotoxic drugs.
  • Stages 4-5: Delay dental treatments until after dialysis; avoid procedures on dialysis days.
  • Emphasize oral hygiene and manage infections aggressively.
• Drug Management:

  Categorize drugs based on CKD severity for dosage adjustments. Avoid nephrotoxic drugs and adjust dosages of other medications as needed.

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