Kidney diseases can be broadly divided into acute and chronic renal failure. Acute renal failure is usually reversible and mostly found in hospitalized patients. Chronic renal failure is progressive and mostly irreversible.
A recent concept for treatment has been coined “BEANS.”
- Blood pressure needs to be maintained below 130/80 mmHg.
- Erythropoietin is given to raise hemoglobin levels to at least 10-12 g/dL.
- Access to dialysis should be created when serum creatinine is above 4.0 mg/dL or glomerular filtration (GFR) drops below 20 mL/min.
- Nutritional status.
- Specialty evaluation by a nephrologist when serum creatinine is above 3 mg/dL.
End-stage renal disease is treated with dialysis while waiting for a renal transplant.
Renal disease is strongly associated with other underlying diseases and conditions, including gastrointestinal symptoms, neuromuscular symptoms, hematologic changes, osteodystrophy, secondary hyperparathyroidism, diabetes, insulin resistance, hypertension, heart failure, cardiac arrest, cardiomyopathy, pericarditis, arrhythmias, and dermatologic changes.
The main manifestations of renal disease are referred to as uremic syndrome.
Signs and symptoms are directly related to altered regulatory and excretory functions and underlying medical conditions. They include nausea, vomiting, anorexia, stomatitis, parotitis, esophageal gastritis, headaches, peripheral neuropathy, impaired coagulation, anemia, impaired growth and development, amenorrhea, high blood pressure, irregular heartbeat, pallor, hyperpigmentation, ecchymosis, and pruritus.
Laboratory values specific for renal disease include GFR, creatinine clearance, serum creatinine, blood urea nitrogen (BUN), serum calcium, serum phosphate, and serum potassium.
Critical values will determine the level of severity of the disease. See also creatinine clearance (CrCl) and glomerular filtration rate (GFR) calculator below.
Impaired hemostasis may be present in severe renal failure. This is mainly due to a decrease in the ability of platelets to adhere to the underlying endothelium. Signs and symptoms may be similar to other platelet disorders.
Renal function affects drug elimination, bioavailability, and metabolism.
Drug regimens may need to be altered for patients with moderate or severe renal failure. Some drugs may be contraindicated.
A method of removing nitrogenous and toxic waste from the blood through a vascular access, usually in a patient’s arm. The access is created by an arteriovenous fistula, a shunt or external cannula, or a subcutaneous artificial arteriovenous graft or through an indwelling central catheter.
Typically, patients have three hemodialysis sessions per week.
This procedure is very tiring, causes mechanical destruction of platelets, and uses a small amount of heparin. Patients are also at an increased risk for hepatitis B virus (HBV), hepatitis C virus (HCV), tuberculosis (TB), and infective endocarditis.
This type of dialysis is achieved by catheter access through the abdominal wall into the peritoneum. Patients usually perform this procedure at home every 6-12 hours, 5-7 days per week.
- Oral Health Care Considerations
- Laboratory Values
- Medical Emergencies
- Classifications and Definitions
- Parsegian K, Trivedi R, Ioannidou E. Renal diseases. In: Glick M, Greenberg MS, Lockhart PB, Challacombe S, eds. Burket’s Oral Medicine. 13th ed. Oxford, UK: Wiley-Blackwell; 2021.