13 Dialysis and Transplants

Question 1

What are the 3 renal replacement therapy options?

Answer 1

dialysis
tranplantation
conservative care

Question 2

What GFR does Dialysis achieve?

Answer 2

less than <15 ml/min

Question 3

What does a semi-permeable membrane filter on?

Answer 3

charge

size

Question 4

What 3 processes does dialysis rely on to allow things through the semi-permeable membrane?

Answer 4

diffusion
osmosis
ultrafiltration

Question 5

What are the 2 types of dialysis?

Answer 5

haemodialysis

peritoneal dialysis

Question 6

What does the fluid contain in peritoneal dialysis?

Answer 6

water
dextrose
sodium, potassium, bicarbonate

Question 7

How long do you leave the fluid for peritoneal dialysis?

Answer 7

4 hours or so

takes maybe 20 mins to cap on / off

Question 8

What problems are associated with peritoneal dialysis?

Answer 8

usually lasts about 8-10 years

risk of peritonitis because fluid is ideal bacterial / fungal growth medium

Question 9

How long does haemodialysis take?

Answer 9

4 hours 3x per week

Question 10

What are the 2 main ways we perform peritoneal dialysis?

Answer 10

continuous

overnight

Question 11

What problems are associated with haemodialysis?

Answer 11

may develop sepsis
clots form in reaction to plastic
if line falls out that’s a major haemorrhage right there matey

Question 12

Why can we use a single standard solution for all haemodialysis patients?

Answer 12

their blood will just equilibrate against the dialysis fluid, so it almost doesn’t even matter what the patient’s level are

Question 13

What is added to the haemodialysis solution to reduce acid load?

Answer 13

bicarbonate

acetate or lactate may also be used as the can be metabolised into bicarbonate

Question 14

When would you start dialysis in CKD?

Answer 14

ideally pre-symptoms

usually when eGFR < 10ml/min

Question 15

When would you start dialysis in AKI?

Answer 15

usually when creatinine >500mmol/L

uraemia

if any of hyperkalaemia, pulmonary oedema, or metabolic acidosis are not controlled medically

Question 16

Why would we want to do a transplant over dialysis?

Answer 16

better life expectancy and QoL
replaces all kidney functions, not just some
first choice treatment for CKD 5

Question 17

Where would the kidney be transplanted to?

Answer 17

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

Question 18

What are absolute contra-indications for transplants?

Answer 18

high peri-operative mortality
poor life expectancy
active malignancy

not that age in isolation is not an absoulte contraindication

Question 19

Name 3 ‘relative contraindications’ of renal transplant

Answer 19

coronary or cerebrovascular disease
recurrent disease
non-complicance

Question 20

Where do kindeys come from?

Answer 20

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

Question 21

What things do we need to watch out for when matching donors with recipients?

Answer 21

ABO blood groups
HLA A,B, DR matching
screening for anti-donor antibodies in recipient

Question 22

Which blood group is a universal donor?

Answer 22

Group O

Question 23

What blood group is a universal recipient?

Answer 23

Group AB

Question 24

What are class I HLA’s?

Answer 24

HLA-A

HLA-B

Question 25

What are class II HLAs?

Answer 25

HLA-DR

Question 26

How can we avoid rejection by the recipient?

Answer 26

make sure they don’t have an existing immune response

stop body developing response (drugs to target T-cell mediated immune resopnse)