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.