fa ارتباط کلیوی-دندانی: نکات کلیدی در تشخیص، درمان و چالش‌های سلامت دهان در بیماری‌های کلیوی دندانپزشکی مروری Review <span style="font-size:15pt"><span style="line-height:17pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span b="" mitra="" style="font-family:"><span style="color:#16469d"><span style="font-weight:bold">چکیده<span class="latin" new="" roman="" style="font-family:" times=""><span dir="LTR" style="font-size:12.5pt"><span style="font-family:Mitra"><span style="font-weight:normal"></span></span></span></span></span></span></span></span></span></span></span><br> <span class="latin" new="" roman="" style="font-family:" times=""><b><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%">زمینه</span></span><span style="font-size:10.0pt"><span style="line-height:107%">:</span></span></b></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> بیماری مزمن کلیه</span></span></span><span style="font-size:10.0pt"><span style="line-height:107%"> (CKD)</span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> به</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">عنوان</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> یک دغدغه جدی در بهداشت جهانی شناخته می</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">شود</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> و پیوند آن با سلامت دهان، به</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">طور</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> فزاینده</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">ای</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> آشکارتر می</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">گردد</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">. این مقاله مروری روایتی، شواهد کنونی در مورد </span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span minion="" pro="" style="font-family:">&ldquo;</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">ارتباط</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> کلیوی</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">-دندانی</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span minion="" pro="" style="font-family:">&rdquo;</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> و رابطه دوطرفه بین عملکرد کلیه و سلامت دهان را بررسی می کند. ابتدا این ارتباط را تعریف کرده و سپس تکامل مفهومی آن را از طریق مدل</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">های</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> کلیدی از جمله </span></span></span><span style="font-size:10.0pt"><span style="line-height:107%">inflammatory bridging</span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">،</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> محور میکروبیوم و نشانگرهای زیستی بزاقی ردیابی می</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">کند</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> و طیف تظاهرات دهانی در بیماران</span></span></span><span style="font-size:10.0pt"><span style="line-height:107%"> CKD</span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">،</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> از بیماری پریودنتال و خشکی دهان گرفته تا استوماتیت اورمیک و تغییر درک چشایی شرح داده می</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">شود</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">. روش</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">های</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> تشخیصی بزاقی و اهمیت غربالگری روتین دهان در مراکز نفرولوژی حایز اهمیت می</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">باشد</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">. ملاحظات درمانی به چالش</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">های</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> مدیریت بیماری پریودنتال، عوارض جانبی داروها و خطرات خاص مرتبط با اقدامات دندانپزشکی در بیماران </span></span></span><span style="font-size:10.0pt"><span style="line-height:107%">CKD</span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> می</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">پردازد</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> و بر نیاز به همکاری بین</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">رشته</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">ای</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> تأکید می</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">کند</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">. پیامدهای عملی برای ارائه</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">دهندگان</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> مراقبت</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">های</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> بهداشتی، بیماران و سیاست</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">گذاران</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> مورد بحث قرار گرفته و در کنار تأملات انتقادی بر مطالعات موجود، شکاف</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">هایی</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> مانند کمبود مطالعات طولی و نیاز به معیارهای تشخیصی استاندارد را شناسایی می</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">کند</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">. این مقاله مروری بر نیاز مبرم به مدل</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">های</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> مراقبت یکپارچه و تحقیقات پیشرفته برای کاهش عواقب سلامت دهان در </span></span></span><span style="font-size:10.0pt"><span style="line-height:107%">CKD</span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> و بهبود نتایج کلی بیماران تأکید می</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">کند</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> و از تغییر پارادایم به سمت مراقبت</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">های</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra"> بهداشتی کلیوی</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">-دندانی جامع و بیمار-محور دفاع می</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span style="font-size:10.0pt"><span style="line-height:107%"><span calibri="" style="font-family:">‌</span></span></span></span><span class="latin" new="" roman="" style="font-family:" times=""><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:Mitra">کند</span></span></span></span> <span style="font-size:11pt"><span style="text-autospace:none"><span style="vertical-align:middle"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:14.0pt"><span style="font-family:IRMitra"><span style="color:#16469d"><span style="letter-spacing:-.05pt">Abstract </span></span></span></span></b></span></span></span></span></span><br> <b><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:IRMitra"><span style="color:black"><span style="letter-spacing:-.05pt">Background:</span></span></span></span></span></b><span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times=""><span style="color:black"> Chronic kidney disease (CKD) stands as a significant global health concern, with its intricate link to oral health becoming increasingly evident. This narrative review navigates the current evidence surrounding the &ldquo;Nephro-Dental Nexus,&rdquo; exploring the bidirectional relationship between renal function and oral well-being. We begin by defining this connection and tracing its conceptual evolution through key models, including inflammatory bridging, the microbiome axis, and salivary biomarkers. The spectrum of oral manifestations in CKD patients is detailed, encompassing conditions from periodontal disease and xerostomia to uremic stomatitis and altered taste perception. Salivary diagnostic methods and the importance of routine oral screening in nephrology centers are highlighted. Therapeutic considerations address the challenges in managing periodontal disease, medication side effects, and specific risks associated with dental procedures in CKD patients, underscoring the necessity for interdisciplinary collaboration. Practical implications for healthcare providers, patients, and policymakers are discussed, alongside critical reflections on existing studies that identify gaps such as the paucity of longitudinal investigations and the need for standardized diagnostic criteria. This review emphasizes the urgent requirement for integrated care models and advanced research to mitigate the oral health consequences of CKD and enhance overall patient outcomes, advocating for a paradigm shift towards comprehensive, patient-centered renal-dental healthcare</span></span></span></span> بیماری مزمن کلیه, ارتباط کلیوی-دندانی, همکاری بین‌رشته‌ای, تظاهرات دهانی, ملاحظات دندانپزشکی CKD, Nephro-Dental Nexus, Interdisciplinary Collaboration, Oral Manifestations, Dental Considerations 12 19 http://jmciri.ir/browse.php?a_code=A-10-1744-3&slc_lang=fa&sid=1 Mahdieh Jamshidian مهدیه جمشیدیان m.jamshidian@shahed.ac.ir 100319475328460011133 100319475328460011133 No Operative Dentistry Department, Shahed Dental School, Shahed University, Tehran, Iran دکترای تخصصی دندانپزشکی ترمیمی، دانشکده دندانپزشکی، دانشگاه علوم پزشکی شاهد، تهران، ایران Banafshe Dormanesh بنفشه درمنش dr.dormanesh@yahoo.com 0050110888 100319475328460011134 Yes Pediatric Nephrology, Pediatric Department, AJA University of Medical Sciences, Tehran, Iran فوق تخصص بیماری کلیه در کودکان، دانشکده پزشکی، دانشگاه علوم پزشکی ارتش، تهران، ایران