Drugs that depend on renal metabolism or excretion should be avoided or used in modified doses to prevent systemic toxicity. Drugs removed during dialysis will also need special dosing regimens. Relatively nephrotoxic
drugs, such as NSAIDs, should also be avoided in patients with seriously compromised kidneys.
Because of the higher incidence at hepatitis in renal dialysis patients, dentists should take the necessary precautions. The altered appearance of bone caused by secondary hyperparathyroidism in patients with renal failure should also be noted. Metabolic radiolucencies should not be mistaken for dental disease (Box I-IS).
Renal transplant and transplant of other organs.The patient requiring surgery after renal or other major’ organ transplantation is usually receiving a variety of drugs to preserve the function of the transplanted tissue. These patients receive corticosteroids and may need supplemental
corticosteroids in the periotopcrative period (see discussion on adrenal insufficiency later in this chapter).
Most of these patients also receive immunosuppressive agents that may cause otherwise self-limiting infections to become severe. Therefore more aggressive use of antibiotics and early hospitalization for infections are warranted.The patient’s primary care physician should be consulted
concerning the need for prophylactic antibiotics .
Cyclosporine A, an immunosuppressive drug administered after organ transplantation, may cause gingival hyperplasia. The dentist performing oral surgery should recognize this so as not to wrongly attribute .gingival,
hyperplasia entirely to hygiene problems.
Patients who have had renal transplants occasionally have problems with severe hypertension. Vital signs should be obtained before oral surgery is performed in these patients (Box 1-16).
Hypcrtension. Chronically elevated blood pressure for which the cause is unknown is called essential hypertension. Mild or moderate hypertension (i.e., systolic pressure of less than 200 or diastolic pressure of less than 110) is usually not a problem to the performance of ambulatory oral surgical care.