⚙️ Renal Disorders

• Acute Kidney Injury:
  • Pre-renal causes: Dehydration, blood loss
  • Post-renal: Obstruction (e.g., stones, tumors)
• Nephrotic Syndrome:
  • ↑ susceptibility to CAD
  • Hallmarks: Proteinuria, hypoalbuminemia, edema, hyperlipidemia

🧪 Electrolytes & Acid-Base

• Hyperkalemia:
  • Side effect of: ACE inhibitors
  • ECG: Tall T waves, widened QRS
• Hyponatremia:
  • Watch for CNS symptoms
  • SIADH common cause in small cell lung CA

💉 Drugs & Renal Impact

High-Yield Numbers

• FBS ≥126 mg/dL (DM diagnosis)
• HbA1C >6.5% (DM diagnosis)
• IGT: 140-199 mg/dL (2-hr GTT)
• Sleep apnea: ≥10 seconds
• Cortisol <3 mg/dL (Addison's)
• ACTH >200 pg/mL (Addison's)
• Nebulizer droplets <2.5 μm

Remember the "Onlys"

• Telmisartan: Only ARB with PPAR-γ activity
• Microalbuminuria: Most reliable diabetic nephropathy marker
• TB: Most common cause of adrenal insufficiency in India
• Melanoma: Most common primary tumor → adrenal mets

Classic Associations

• Type 1 DM: HLA-DR3/DR4, Anti-GAD antibodies
• Aspirin asthma: Nasal polyps
• Emphysema: Weight loss, pneumothorax, ↓DLCO
• Chronic bronchitis: Polycythemia, Reid's index

• Budd-Chiari:
  • Cause: PNH or Polycythemia vera
  • Common site: Hepatic veins
• Wilson Disease:
  • Autosomal recessive < age 40
  • Excess copper in liver + brain

Plaque Formation

Dental plaque is a biofilm that forms on the surfaces of teeth and is a key factor in the development of dental caries and periodontal disease. The process of plaque formation can be divided into three major phases:

1. Formation of Pellicle on the Tooth Surface

• Definition: The pellicle is a thin, acellular film that forms on the tooth surface shortly after cleaning.
• Composition: It is primarily composed of salivary glycoproteins and other proteins that are adsorbed onto the enamel surface.
• Function:
  • The pellicle serves as a protective barrier for the tooth surface.
  • It provides a substrate for bacterial adhesion, facilitating the subsequent stages of plaque formation.

2. Initial Adhesion & Attachment of Bacteria

• Mechanism:
  • Bacteria in the oral cavity begin to adhere to the pellicle-coated tooth surface.
  • This initial adhesion is mediated by specific interactions between bacterial adhesins (surface proteins) and the components of the pellicle.
• Key Bacterial Species:
  • Primary colonizers, such as Streptococcus sanguis and Actinomyces viscosus, are among the first to attach.
• Importance:
  • Successful adhesion is crucial for the establishment of plaque, as it allows for the accumulation of additional bacteria.

3. Colonization & Plaque Maturation

• Colonization:
  • Once initial bacteria have adhered, they proliferate and create a more complex community.
  • Secondary colonizers, including gram-negative anaerobic bacteria, begin to join the biofilm.
• Plaque Maturation:
  • As the plaque matures, it develops a three-dimensional structure, with different bacterial species occupying specific niches within the biofilm.
  • The matrix of extracellular polysaccharides and salivary glycoproteins becomes more pronounced, providing structural integrity to the plaque.
• Coaggregation:
  • Different bacterial species can adhere to one another through coaggregation, enhancing the complexity of the plaque community.

Composition of Plaque

• Matrix Composition:
  • Plaque is primarily composed of bacteria embedded in a matrix of salivary glycoproteins and extracellular polysaccharides.
• Implications for Removal:
  • The dense and cohesive nature of this matrix makes it difficult to remove plaque through simple rinsing or the use of sprays.
  • Effective plaque removal typically requires mechanical means, such as brushing and flossing, to disrupt the biofilm structure.

Sharpening Stones

• Natural: India, Arkansas
• Artificial: Ruby, Carborundum, Ceramic

Surgical Equipment

• Dental loupes: 1.5 – 6× magnification
• Coe – pak working time: 15 – 20 minutes

Preventive Measures

• Calculus control toothpastes: Contain pyrophosphates
• Antibiotic prophylaxis: Amoxicillin 2.0g, 30 – 60 min before procedure

Abrasion Rates

• Dentin: 25× faster than enamel
• Cementum: 35× faster than enamel

• Steroids, Thiazides, Niacin, Phenytoin
• Protease inhibitors, Alpha IF, Clozapine, Beta agonists

🧠 Endocrine-Related DM

• Cushing’s, Acromegaly, Pheochromocytoma
• Thyroid disorders, Glucagonoma, Somatostatinoma
• (Note: Hypoglycemia in Addison's disease)

💓 Cardiovascular & Renal

• ↑GFR → Earliest sign of diabetic nephropathy
• Microalbuminuria → Most reliable marker
• ACEIs → Nephroprotective, but contraindicated in CRF (hyperkalemia)

👁️‍🗨️ Complications

• Wet gangrene, Blindness, Amputation (2nd most common after trauma)

💊 Special Drug Mention

• Telmisartan → Only ARB acting on PPAR-γ → preferred in DM