CHAPTER 32. Renal disease
Renal disease has become important in dentistry because of the growing number of patients who, as a result of renal dialysis or transplantation, survive renal failure. Aspects of renal disease relevant to dentistry are summarised in Box 32.1.
• Heparinisation before dialysis
• Possible hepatitis B or C carriage after chronic dialysis
• Permanent venous fistulae susceptible to infection
• Secondary hyperparathyroidism
• Immunosuppressive treatment for nephrotic syndrome or transplant patients
• Oral lesions due to drugs, particularly for immunosuppression
• Lower doses or withholding of many drugs: e.g. some cephalosporins and tetracyclines
• Oral lesions of chronic renal failure (Box 32.2)
CHRONIC RENAL FAILURE
Some patients are unsuitable for, or unable to obtain, dialysis or a transplant. They can suffer a variety of oral effects (Box 32.2).
• Mucosal pallor (anaemia)
• Mucosal ulceration
• Thrush or bacterial plaques
• White epithelial plaques (Ch. 15)
• Giant-cell lesions of the jaws (secondary hyperparathyroidism)
Dental management of patients with renal disease, but particularly chronic renal failure, may be affected by many factors (Box 32.3).