OBLENA, JANE DIANNE C.

SEPTEMBER 21, 2016

DHD 422 DHB

KIDNEY FAILURE
Kidneys are two bean-shaped organs, each about the size of a fist. They are located just
below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to
150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid.
The urine flows from the kidneys to the bladder through two thin tubes of muscle called ureters,
one on each side of the bladder. The bladder stores urine. The muscles of the bladder wall
remain relaxed while the bladder fills with urine. As the bladder fills to capacity, signals sent to
the brain tell a person to find a toilet soon. When the bladder empties, urine flows out of the
body through a tube called the urethra, located at the bottom of the bladder. In men the urethra
is long, while in women it is short.
When your kidneys fail, harmful wastes and extra fluid build up in your body, which can
cause darkened skin, dry skin, edema (usually in the legs, feet, or ankles and less often in the
hands or face), generalized itching or numbness, headaches, high blood pressure, little or no
urination, loss of appetite, muscle cramps, nausea, sleep problems, drowsiness, fatigue, or
feeling tired, trouble concentrating, vomiting, weight loss. When these conditions occur, you
need treatment to replace the work your damaged kidneys have stopped doing. Left untreated,
kidney failure will lead to coma, seizures, and death.
The three treatment options to choose from to filter your blood are hemodialysis,
peritoneal dialysis, and kidney transplantation but one of these treatments helps the kidneys get
better. However, they all can help you feel better.
The purpose of kidney transplantation is to surgically place a healthy kidney from a
donor (a person who has just died or a living person, most often a family member) into your
body. A kidney from someone who has just died is a deceased donor kidney. A kidney from a
living person is a living donor kidney. A functioning kidney transplant does a better job of filtering
wastes and keeping you healthy than dialysis.
Surgeons place most transplanted kidneys in the lower front part of your abdomen. The
kidney is connected to an artery, which brings unfiltered blood into the kidney, and a vein, which
takes filtered blood out of the kidney. The surgeon also transplants the ureter from the donor to
let urine from the new kidney flow to your bladder. Unless your damaged kidneys cause
problems such as infection, they can remain in their normal position. The transplanted kidney
takes over the job of filtering your blood. Your body normally attacks anything it sees as foreign,
so to keep your body from attacking the kidney you need to take medicines called
immunosuppressants for as long as the transplanted kidney functions.
For the advantages of kidney transplantation, patients have fewer dietary restrictions,
transplanted kidney works like a healthy kidney, patients may feel healthier and have an
improved quality of life, fewer dietary restrictions, wont need dialysis and if patient have a living

donor, he can choose the time of his operation. Therefore, people who receive a donated kidney
have a greater chance of living a longer life than those who stay on dialysis.
For the disadvantages of kidney transplantation, patient will go through extensive
medical testing at the transplant clinic, he may need to wait years for a deceased donor kidney,
body may reject the new kidney, so one transplant may not last a lifetime and will need to take
immunosuppressants, which may cause other health problems, for as long as the transplanted
kidney functions.
Before performing any transplant we must consider general dental management such as
consultation with the physician to discuss overall condition of the patient, we must educate,
inform and motivate the patient to maintain a proper oral hygiene and to be aware of the risk
and problems that may arise in the oral cavity after transplant. We must give oral hygiene
instructions and recommend the use of fluorinated compounds and antiseptic mouthwashes
such as chlorhexidine. Dental status should be evaluated. For dental treatment planning, we
must carry out a radiographic study and we must be careful with the use of certain drugs
including general anesthesia, nonsteroidal anti-inflammatory drugs, antibiotics, co-trimoxazole,
tetracyclines, aminoglycosides and quinolones.
The general dental management after transplant for the first three months after surgery
is that it is recommended that emergency dental treatment be carried out in a hospital, and that
specialist be consulted and treated with antibiotic prophylaxis. The dental treatment will be
essentially palliative and local, the aim is to prevent hyposalivation and xerostoma, educate the
patient about oral hygiene, eliminate risk factors and improve the diet, remove dentures and
orthodontic appliances, dental examination by the risk of developing malignant lesions and
prevention of infections.
Special dental management for kidney transplant patients: Before kidney transplant, we
must be careful with the use of some drugs in patients with end-stage renal disease because as
renal function is reduced, the plasma levels of some drugs may be high or prolonged.
Acetaminophen and codeine can be given for postoperative pain management. Local
anesthetics are metabolized in the liver and hence are safe to use for dental procedures.