Why should I be concerned of my kidney disease before going to the dentist?


Normal healthy patients have the minimum risks during oral surgery. Since the advent of a new kind of diet which is composed of mostly preserved, fully laden with additives, salty, msg etc., kidney disease becomes more of a lifestyle disease.

Understanding its difference from management of patients with kidney disease would have significant success on treatment. Here are a few explanations as to why.


What is the role of the kidneys in our body?

1) The blood is filtered from its toxicities such as the nitrogenous wastes.

2) It also regulates the fluid volume and acid base balance of the plasma in blood which means it keeps the body sustained with proper fluid volume.

3) It also synthesizes a number of products for drug metabolism such as erythropoietin, 1,25-dihydroxycholecalciferol, and renin.

4) serves as the target organ for parathormone and aldosterone


Dentists should have proper recognition of the status of the disease. There are stages depending on the decline of kidney function. The last stage is reflected by kidney failure. This happens when 75% or around 2 million nephrons are already destroyed. When this happens, the balance in the endocrine functions of the body becomes screwed up.


When a patient has a chronic kidney disease, the only thing that it ends up to is kidney failure. Now, kidney disease is associated with a lot of other medical conditions. It can lead to multiple organ system effects on cardiovascular, hematologic, neuromuscular, endocrine, gastrointestinal, and dermatologic manifestations. Some of these are:


1) anemia

2) abnormal bleeding

3) electrolyte and fluid imbalance

4) hypertension

5) drug intolerance

6) skeletal abnormalities


Since the body is a connected network of system, the main filtration system affects the other organs. But the irony is, clinical signs and symptoms only show in stage 3. Some of these patients feel ill, fatigue, headaches, nausea, loss of appetite and weight lossSkin may be pale or hyperpigmented with brownish-yellow appearance. Patients also feel bone pain, anorexia, vomiting, gastroenteritis and peptic ulcer disease. They may also exhibit peripheral neuropathy and muscular twitching.

One of the most concern for the dentist is the bleeding diatheses that goes with CKD. There is also hypertension, congestive heart failure, and pericarditis. They can have signs of orthopnea, dyspnea and peripheral edema. This could be correlated to the kind of surgical procedure to be done. The best approach for these patients dwells into careful management.


What to know before oral surgery?


Patients with CKD (chronic kidney disease) of stage 4 or higher should have consultation with the physician before undergoing procedures that involves blood. If patient has other condition such as diabetes, then maybe it is best to have clearance first. Blood pressure should be monitored before and after the procedure. Because the blood pressure has to be maintained to prevent bleeding.


If the procedure is slightly invasive, the patient should be checked for bleeding tendencies (PT/PTT, platelet, hematocrit and hemoglobin). If the hematocrit is low, it should be raised by erythropoietin under the guidance of physician.


When there is invasive treatment such as surgery, the physician should be consulted for the need for pre-operative antibiotics.


There is also a concern on the kind and dosage of drugs prescribed. There are different kind of drugs such as acyclovir, aminoglycosides, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), and tetracycline should have special considerations in dosage. Acetaminophen is nephrotoxic which may cause further  damage to the kidney at high doses but since it is metabolized in the liver,it is safer than aspirin which is metabolized in the kidneys.


Some drugs have severe adverse effects on the already damaged functions. Since the albumin is damaged, there are no binding sites therefore a lot will be left circulating in blood. Antacids, and aspirin can further increase bad effects.


Not only these common drugs can affect the over-all function but also the nitrous oxide, diazepam, barbiturates, narcotics. This can lead to excessive effects to the central nervous system to the effects of uremia in blood brain barrier. Meperidine shouldalso be prevented because thismay cause seizures.


With all of these contraindications, it is still opt to go to a dental clinic that deals and is informed of the relation of kidney disease to dental procedures. Ask your dentist for any concerns before undergoing any surgical procedure.