Dental problems in a potential kidney transplant recipient: case report and literature review

Renal failure is associated with many abnormalities in the oral and dental health status. The aim of this study was to describe dental treatment procedures in a patient on the waiting list for kidney transplantation.

We treated a 46-year-old female with ESRD due to reflux nephropathy who was dialyzed peritoneally for 8 years. She received a cadaveric kidney transplant in 2003. Her immunosuppression consisted of prograf, MMF, and steroids. Creatinine after Tx was 1.58 mg/dL rising to 2 mg/dL 6 months later. Transplant biopsy in 2005 (creatinine 3.5 mg/dL) revealed chronic thrombotic microangiopathy. Four years after Tx she entered the PD program to eliminate odontogenic foci of infection. Pantomography and digital radiography disclosed the presence of three teeth classified as potential centers of inflammation. The methods of treatment were: (1) surgical extraction with filling of the bone defect with BioOss bone substitute material and application of Bio-Gide collagen membrane; (2) extirpation of inflamed pulp under anaesthesia; (3) antiseptic endodontic treatment.

Clinical and radiologic examination revealed normal bone healing and normal condition of periapical tissues.

Elimination of odontogenic centers of inflammation in patients before kidney transplantation should be the goal of a precisely planned multi-specialist treatment. Prevention of odontogenic inflammation must be started as soon as possible in the pre-dialysis period since periodontal diseases are a significant cause of generalized inflammation accelerating progression of atherosclerosis and its complications.