[Oral lesions associated to immunosuppression in kidney transplant patients]. / Lesiones bucales asociadas a inmunosupresión en pacientes con trasplante renal.

BACKGROUND: The use of immunosuppresive drugs in patients with kidney transplantation (KT) could influence the development of oral lesions (OL). The aim of this study was to establish the OL prevalence in a group of KT patients, and explore some possible associations of their presence. METHODS: Cross-sectional study. We examined the oral mucosa (OM) of 190 KT patients searching for OL. Our findings were analyzed by multiple logistic regression, and possible associations between OLs and several variables (demographic, clinical, of immunosuppressor drugs, and of lab results) were explored. RESULTS: Overall OL prevalence was 28.4 %; 15.8 % had oral candidiasis (which was more prevalent in diabetic cases, p = 0.002), herpes simplex 7.4 %, hairy leukoplakia 5.3 %, oral verruca vulgaris 3.7 %, and OM ulcers 2.6 %. The combination of cyclosporin A + azathioprine + prednisone had the highest OL prevalence. Hairy leukoplakia was related to a lower total leukocyte count, p = 0.006, and oral verruca vulgaris to a cadaveric KT donor. CONCLUSIONS: Oral candidiasis was the most prevalent OL, and it was more prevalent in diabetic cases. The association of hairy leukoplakia to a lower total leukocyte count might agree with previous reports classifying it as an immunosuppression marker.

Introducción: el uso de medicamentos inmunosupresores en pacientes con trasplante renal (TR) predispone el desarrollo lesiones bucales (LB) asociadas a inmunosupresión. El objetivo de este estudio fue determinar la prevalencia de LB en un grupo de pacientes con TR y explorar algunas posibles asociaciones de presencia. Métodos: estudio transversal en el que se examinó la mucosa bucal de 190 pacientes con TR, en búsqueda de LB. Los hallazgos se analizaron mediante regresión logística múltiple y se exploraron posibles asociaciones entre las LB y variables demográficas, clínicas, de los medicamentos inmunosupresores, y de laboratorio. Resultados: la prevalencia de LB fue de 28.4 %; la candidiasis bucal (CB), con 15.8 %, fue más frecuente en diabéticos (p = 0.002); el herpes simple 7.4 %; la leucoplasia vellosa 5.3 %; las verrugas vulgares peribucales 3.7 %, y las úlceras 2.6 %. La combinación de ciclosporina A + azatioprina + prednisona tuvo la mayor frecuencia de LB. La leucoplasia vellosa se asoció a una cifra más baja de leucocitos totales (p = 0.006) y las verrugas peribucales a TR de donador cadavérico. Conclusión: la LB más frecuente fue la CB, la cual fue más frecuente en diabéticos. La asociación de leucoplasia vellosa con una cuenta más baja de leucocitos concuerda con su clasificación previa como marcador de inmunosupresión.

Oral colonisation and infection by Candida sp. in diabetic and non-diabetic patients with chronic kidney disease on dialysis.

INTRODUCTION: Oral candidiasis (OC) is a common opportunistic infection in immunocompromised patients. Species identification is sometimes important for treatment. objective: to determine the prevalence of different Candida species colonising or infecting the oral mucosa (OM) of diabetic (DM) and non-diabetic (non-DM) chronic kidney disease patients, comparing both groups and exploring potential risk factors. METHODS: 56 DM and 80 non-DM patients on chronic dialysis were examined. OM swabs were cultured on Sabouraud dextrose agar plates. Candida species were identified with API® galleries. OC was confirmed by exfoliative cytology. Statistical associations were analysed using χ2, Fisher's exact test (ET), and multiple logistic regression. RESULTS: Candida prevalence was 43.4%: 53.6% DM and 36.3% non-DM, (p=.045). The species identified were C. albicans 74.6%, C. glabrata 22.0%, C. tropicalis 15.2%, C. parapsilosis 3.4 %, C. kefyr 3.4% and C. famata 1.7% without difference between groups. DM patients had a higher xerostomia prevalence (p=.002) and lower salivary flow (p=.008) and lower serum albumin (p=.018). 16.9% of patients had OC, 23.2% DM compared with 12.5% non-DM, (p=.101). The following were associated with the presence of Candida in the OM: the use of dental prostheses (odds ratio [OR] 25.6, 95% confidence interval [CI] 2.5 to 253, P=.001), xerostomia (OR 9.6, 95% CI 2.4 to 38.1, P=.001) and low serum albumin values (OR 0.41, 95% CI 0.22 to 0.98, P=.044). CONCLUSIONS: The presence of Candida sp. in the OM was associated with dental prostheses, xerostomia and low serum albumin.

[Periodontal disease in type 2 diabetes patients with and without chronic renal failure]. / Enfermedad periodontal en pacientes diabéticos con y sin insuficiencia renal crónica.

OBJECTIVE: To estimate and compare periodontal disease prevalence (PD) in two groups of patients with type 2 diabetes (T2D), with and without end stage renal disease (ESRD) and dialysis. MATERIAL AND METHODS: Using a cross sectional design, two groups of patients with type 2 diabetes were examined in two general hospitals belonging to Instituto Mexicano del Seguro Social in San Luis Potosí. Group A were patients with ESRD and dialysis; Group B, patients with serum creatinine < 2.0 mg/dL. The WHO Community Periodontal Index (CPI) was used to assess PD. 233 patients were examined among which 172 had functional tooth, suitable for PD evaluation. RESULTS: 71 patients integrated group A; their mean age was 56.2 +/- 11.8 years. 101 patients integrated group B, their mean age was 56.7 +/- 11.9 years (p = 0.768). Elapsed time from T2D diagnosis was 221 +/- 86 months for group A, and 126 +/- 101 months for group B (p < 0.001). Poor oral hygiene was found in 39.8 % of group A patients, and 34.6 % of group B patients (p = 0.133). PD prevalence, with CPI scores 3 and 4, was 63.4 % for group A, and 72.3 % for group B (p = 0.216). Multiple linear regression analysis found PD severity associated to ageing (p < 0.001), poor oral hygiene (p < 0.001) and for group A a shorter time from T2D diagnosis to ESRD (p = 0.0315). ESRD hemodialysis patient's PD was more severe than that of peritoneal dialysis patients (p < 0.03). CONCLUSIONS: both groups had high prevalence of PD and poor oral hygiene. Patients treated with haemodialysis had more severe PD than peritoneal dialysis patients. A shorter time from DM diagnosis to ESRD was found associated to more severe PD.

Oral mucosa symptoms, signs and lesions, in end stage renal disease and non-end stage renal disease diabetic patients.

AIM: To assess oral signs, symptoms and oral lesions (OL) type and prevalence, in diabetic patients with end stage renal disease (ESRD DM), and compare them with analogous findings in a non-ESRD DM group; analyze the possible association between oral manifestations, as well as with relevant laboratory findings. Research design. Two adult groups were studied: Group A: ESRD DM on dialysis, and group B: non-ESRD DM (serum creatinine <2.0 mg/dl). Known DM evolution time, dialysis treatment type and duration, and laboratory results were recorded. An oral exam was performed, searching for signs, symptoms and ESRD-associated OL. Associations were analyzed using Chi square, Fisher s exact test, and odds ratios (OR) with 95% confidence intervals. Ages, time on dialysis, and laboratory results were compared with Student s t test. RESULTS: 229 individuals were examined, group A 99, and group B 130 pts. Signs and symptoms prevalence was higher in group A: 77.8% vs. 57.6%, (P<0.001), uremic breath (48.5%), unpleasant taste (45.5%) and xerostomia (44.4%) being the most frequent ones. OL were also more prevalent in group A; 65.6% vs. 36.9% (P<0.001). The most frequent OL were dry, fissured lips (28.3%), saburral tongue (18.2%) and candidiasis (17.2%). No difference was found in candidiasis prevalence between groups. Candidiasis was found associated to xerostomia (P<0.05) and smooth tongue (P<0.05) only in group A. CONCLUSIONS: ESRD DM patients had a significantly higher prevalence of signs, symptoms and OLs, as compared to non-ESRD DM pts. The high prevalence of uremic fetor, xerostomia, saburral tongue and candidiasis in group A, could be tried as warning signs on the possibility of non diagnosed advanced renal disease in other diabetic patients.

Oral lesions in a group of kidney transplant patients.

AIM: To assess the prevalence of oral mucosa lesions (OL) in a group of kidney transplant (KT) patients, and analyze possible OL associations with one another and with drugs use and relevant clinical and laboratory variables. METHODOLOGY: Transversal study, in which consecutive KT patients from the nephrology outpatient service at a General Zonal Hospital were examined. The prevalence of several types of OL was assessed, and their possible statistical associations with one another and total leukocyte count, renal function, the simplified oral hygiene index (S-OHI), cyclosporin-A (CsA) dose and blood levels, and nifedipine use was analyzed. A logistic regression model was used to analyze the association between gingival hyperplasia (GH) and CsA dose and nifedipine use. RESULTS: Fifty (55.6%) men and forty (44.4%) women were studied. Sixty percent of the patients had at least one OL. Oral candidiasis (OC) was found in 18.7%; 13% had lesions clinically compatible with hairy leukoplakia (CHL). An association was found between OC and CHL (P<0.05). Saburral tongue (ST) was found in 22% of the patients and gingival hyperplasia (GH) in 49%, which was distributed as follows: Grade 1 in 11 (12.2%); Grade 2 in 26 (28.9%), and Grade 3 in 7 (7.8%). Logistic regression results showed an association between GH and poor oral hygiene (P< 0.001), but not to either CsA dose or blood levels, or nifedipine use (P=0.075). CONCLUSION: Sixty percent of the KT patients had at least one OL. The association between GH and poor oral hygiene corroborate the need for oral hygiene practices supervision in the transplant patient.