FACTA UNIVERSITATIS Series: Medicine and Biology Vol.10, No 2, 2003, pp. 57 - 61 UC 616.61:616.31]:615.33 THE SIGNIFICANCE OF DENTAL FOCI IN GLOMERULAR NEPHROPATHIES Gh. Gluhovschi, V. Trandafirescu, A. Schiller, L. Petrica, S. Velciov, G. Bozdog, F. Bob, C. Gluhovschi Dept. of Nephrology, University of Medicine and Pharmacy "Victor Babes" Timisoara Summary. In our study we want to reveal the role of dental foci, compared to other localized infections, in the evolution of glomerular nephropathies. Therefore we followed up the link between the presence of these foci and the flare-up of glomerular nephropathies, with or without renal failure. A number of 328 patients with glomerulonephritis, primary or secondary, hospitalized in the Nephrology Department of Timisoara during the period 1997-2002, were studied retrospectively. The patients were split up in 4 groups. The 240 patients of the control group (glomerulonephritis without any infection) had the following mean values of BUN, serum creatinine and proteinuria: 84.10±69.85 mg%, 3.11±2.97 mg%, 2.33±1.79 g/24h. In the 52 patients with infections other than dental foci we observed, after antibiotic treatment, a statistically significant decrease of proteinuria (from 2.51±1.75 g/24h to 1.96±1.27 g/24h) and of BUN (from 125.10±78.97 to 104.3±63.25 mg%). In the 16 patients with dental foci associated with other infections we observed, after antibiotic ± stomatologic treatment, a statistically significant decrease of proteinuria (2.34±1.74 g/24h- 1. 76±1.4 g/24h). Concerning the 20 patients with dental foci, mean proteinuria decreased from 2.11±1.63 g/24h to 1.79±1.26 g/24h. In some patients, after stomatological treatment, we observed an increase of proteinuria, BUN or serum creatinine, possibly due to the treatment of the localized infection, despite a correct prophylactic antibiotic treatment that could not prevent interactions of the dental foci with the kidney. Key words: Glomerulonephritis, dental foci, localized infections, antibiotic prophylaxis Introduction In the pathogenesis and evolution of glomerular ne- phropathies, localized infections play an important role. Attention is usually focused on upper respiratory tract infections (pharyngeal, tonsillar and sinusal), less impor- tance being given to dental foci. Because in the clinical practice the latter are frequently found associated with glomerulopathies, we tried to analyze their incidence, and at the same time the evolution of the renal disease after a specific stomatologic treatment of dental foci. Renal patients appear to be predisposed to a variety of dental problems such as periodontal disease, nar- rowing of the pulp chamber, enamel abnormalities, premature tooth loss and xerostomia (1). A normal healthy person is colonized by aerobic and anaerobic bacteria in the mouth. These bacteria, and particularly Streptococcus mutans, contribute to a dense microbial mass called dental plaque, a major cause of tooth decay (2). Infections in the mouth can develop into chronic lo- calized infections. The dental surface represents a good environment for bacterial colonization, and for the for- mation of dental plaque. It is a known fact that there is a close link between dental plaque formation and periodontopathies. The latter develop as a result of complex interactions be- tween the host and the local dental plaque. The infec- tions can localize in the pulp of a tooth, developing acute pulpitis. On the other hand, a chronic evolution could lead to the formation of dental granuloma; in this case the infection could last longer. In the evolution of these infections acute phases may occur, despite the fact that the organism tries to isolate these foci by forming an external layer of fibrin and connective tissue. In these phases, germs or parts of them- toxins, that is, could get into the circulation. They could produce various lesions in other tissues, either directly or indirectly, by forming immune complexes. These are deposited in different tissues, where they can activate different factors, like the complement. The kidneys could represent the target organ in this process. This mechanism is described during the course of upper respiratory tract infections: tonsillitis, pharyngitis, sinusitis, otitis as well as visceral infections, which could develop into abscesses, like suppurated appendi- citis, for example. Chronic foci are frequent, and they are defined as localized chronic inflammatory processes, which through different pathogenic mechanisms can develop vegetative disorders, vascular disorders, and lesional manifestations. The diagnosis and correct treatment of infectious foci with a role in the etiology or progression of glomerular