Definition

Normal Glomerulus filtration rate = 125ml/1.73m². *The lost nephrons are not replaced.

• Stage 1: slightly higher GFR, slight decline in renal function(10-20%)

• Stage 2: 20-50% decreased in GFR

• Stage 3: >50-75% decrease in filtration rate, disease progresses easily

• Stage 4: 75-90%

• Stage 5: renal failure(End Stage Renal Disease:ESRD), GFR < 15mL/min

  • Build up of non-protein nitrogen compound in blood is measured with BUN(blood urea nitrogen)

Etiology

• Diabetes mellitus(44%)
• Hypertension(28%)
• Chronic Glomerulonephritis(16%):SLE, Infection, Autoimmune

Pathophysiology and complications

• Various diseases affect different parts in nephron(the glomerulus, tubule, vasculature) then the increased load on the other parts makes it all failed eventually.
  • eg. Hypertension attacks vasculature first, Glomerulonephritis attacks glomeruli first.
  • the nephrons that are lost are not replaced
• Normal funtion is maintained until more than 50% of nephrons are damaged (CKD stage 3)
• In early renal disease, sodium pumps decrease its function(less sodium retained), and sodium loss occur which result in excessive amount of dilute urine and polyuria.
• In advanced renal disease(ESRD), there are very few glomerulus remained, so kidneys are unable to concentrate, which causes dropping urine output, electrolyte exceed, fluid overload, which results in hypertension, insulin resistance, severe electrolyte balance(sodium depletion, hyperkalemia), cardiac diseases
  • Patient also get uremia/azotemia(high blood urea), blood acidosis(waste retention cause acidic blood) which can cause hyperventilate(body try to get rid of CO2 to soften acidic blood), nausea, anorexia, and fatigue.
  • Acidosis cause body to compensate a lot, which any increase in demand, such as fever, sepsis, can cause serious lethal consequence.

Dental management

• Drug adjustment

  • Two methods in adjustment: (1) dosage reduction and (2) Interval extension btw dosage. Ether or both method can be used.
    • Acetamenophen