13 Dialysis and Transplants Flashcards
What are the 3 renal replacement therapy options?
dialysis
tranplantation
conservative care
What GFR does Dialysis achieve?
less than <15 ml/min
What does a semi-permeable membrane filter on?
charge
size
What 3 processes does dialysis rely on to allow things through the semi-permeable membrane?
diffusion
osmosis
ultrafiltration
What are the 2 types of dialysis?
haemodialysis
peritoneal dialysis
What does the fluid contain in peritoneal dialysis?
water
dextrose
sodium, potassium, bicarbonate
How long do you leave the fluid for peritoneal dialysis?
4 hours or so
takes maybe 20 mins to cap on / off
What problems are associated with peritoneal dialysis?
usually lasts about 8-10 years
risk of peritonitis because fluid is ideal bacterial / fungal growth medium
How long does haemodialysis take?
4 hours 3x per week
What are the 2 main ways we perform peritoneal dialysis?
continuous
overnight
What problems are associated with haemodialysis?
may develop sepsis
clots form in reaction to plastic
if line falls out that’s a major haemorrhage right there matey
Why can we use a single standard solution for all haemodialysis patients?
their blood will just equilibrate against the dialysis fluid, so it almost doesn’t even matter what the patient’s level are
What is added to the haemodialysis solution to reduce acid load?
bicarbonate
acetate or lactate may also be used as the can be metabolised into bicarbonate
When would you start dialysis in CKD?
ideally pre-symptoms
usually when eGFR < 10ml/min
When would you start dialysis in AKI?
usually when creatinine >500mmol/L
uraemia
if any of hyperkalaemia, pulmonary oedema, or metabolic acidosis are not controlled medically
Why would we want to do a transplant over dialysis?
better life expectancy and QoL
replaces all kidney functions, not just some
first choice treatment for CKD 5
Where would the kidney be transplanted to?
usually in iliac fossa, outside the peritoneum
it is usually attached to iliac vessels
the native kidneys are left along if they’re not doing anything bad
What are absolute contra-indications for transplants?
high peri-operative mortality
poor life expectancy
active malignancy
not that age in isolation is not an absoulte contraindication
Name 3 ‘relative contraindications’ of renal transplant
coronary or cerebrovascular disease
recurrent disease
non-complicance
Where do kindeys come from?
dead people (brain stem dead to non-heart beating) need to be assessed within 30 mins though
living donors
must have 2 working kidneys and be otherwise well
What things do we need to watch out for when matching donors with recipients?
ABO blood groups
HLA A,B, DR matching
screening for anti-donor antibodies in recipient
Which blood group is a universal donor?
Group O
What blood group is a universal recipient?
Group AB
What are class I HLA’s?
HLA-A
HLA-B
