ORAL CONDITIONS IN RENAL DISORDERS
INTRODUCTION: The prevalence of chronic renal disease (CKD) is increasing worldwide. Common renal disorders seen in both adult and children include congenital nephropathies, nephrotic syndrome, chronic renal failure (CRF), glomerulonephritis, hydronephrosis, and multicystic renal dysplasia, which ultimately lead to end-stage renal disease (ESRD).
CKD is a progressive and irreversible decline in the total number of functioning nephrons, and ESRD is the stage when renal replacement therapy by dialysis or transplantation is required.
CLINICAL MANIFESTATION: Clinical signs and symptoms of renal failure are collectively termed as uremia. Uremia is a state of intoxication that involves multiple extrarenal systems, such as the bone, heart, vasculature, and lungs. Renal disorders affect most parts of the body, and the clinical features depend on the stage of renal failure and the systems involved. Pallor due to anemia, platelet dysfunction, impaired cell-mediated immunity, signs of fluid overload, hypertension, flow murmurs, pruritis, metabolic acidosis, pulmonary edema, and renal osteodystrophy are common signs of Renal disorders.
ORAL MANIFESTATION: Oral conditions are symptoms or conditions in the mouth that can occurs as a result of diseases affecting other organs that are observed in 90% of patients with renal disorders, Anemia, Renal osteodystrophy, Platelet aggregation, altered taste sensations, dysgeusia, as well as bacterial and candidiasis infections can develop due to the underlying renal disorders. A common oral symptom of CRF is the sensation of a dry mouth, which may be caused by restricted fluid intake (necessary to accommodate the reduced excretory capacity of the kidney), adverse effects of drug therapy, and the low salivary flow rate.
MEDICAL MANAGEMENT of renal disease depends on the stage of disease and clinical status of the patient. Management may include dietary changes, administration of sodium bicarbonate to reduce metabolic acidosis, and correction of systemic complications. In early renal disease, dietary modifications can minimize the effects of kidney failure and perhaps slow disease progression. Patients are administered vitamin D supplements to treat hypocalcemia. Elevated potassium levels can be treated by reducing the dietary intake of potassium-rich fruits like bananas. Restriction of sodium helps to control blood pressure. Vitamin D compounds combined with phosphorus-binding agents can treat renal osteodystrophy.
CONCLUSION: About 90% of patients with CRF suffer from at least one hard and/or soft oral tissue lesion. Gingival enlargement, dry mouth, metallic taste, changes in enamel development, periodontitis, decreased tooth decay, are some of the manifestations that can be observed. The treating physician is a central part of the team to provide proper care and ensure a better quality of life for these patients.
Source: The Saudi Dental Journal Volume 27, Issue 3, July 2015, Pages 113-119