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BRS UROLOGY & RENAL > 1b Dialysis and Kidney Transplant > Flashcards

1b Dialysis and Kidney Transplant Flashcards

1
Q

Differentiate between AKI and CKD?

A

AKI —>present before creatinine gets very bad; often normal sized kidneys; acutely unwell

CKD–> present with higher creatinine usually due to secondary trigger (eg.infection);often small kidneys; Patients are often asymptomatic and CKD is discovered incidentally on routine screening or workup of unrelated diseases

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2
Q

What can cause AKI?

A

NSAIDS can cause tubulointerstitial nephritis
ACEi predispose to AKI

Infection—>sepsis—>hypotension—>AKI

Dehydration

Hypovolemic states like an acute hemorrhage, gastrointestinal losses- like with diarrhea and vomiting, renal losses

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3
Q

What can cause CKD?

A

Diabetes
Lupus
Hypertension
Infection
Systemic diseases
Long term use of NSAIDs

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4
Q

What treatment should be considered for a patient presenting with AKI or CKD and hyperkalaemia?

A

Treatment relies on urgent dialysis or a temporizing measures until dialysis can be arranged.

Adress hyperkalaemia

ECG changes?

Urinating? if yes—>diuretics, IV bicarbonate, IV calcium gluconate, IV insulin to correct hyperkalaemia

Potassium binders

Dialysis

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5
Q

What are the two different types of dialysis?

A

Haemodialysis and Peritoneal dialysis

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6
Q

What is the dialysate in dialysis?

A

Dialysate is a solution of pure water, electrolytes and salts, such as bicarbonate and sodium.The purpose of dialysate is to pull toxins from the blood into the dialysate

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7
Q

How does peritoneal dialysis work?

A

The inside lining of your own belly acts as a natural filter.

You will need a minor operation to place a catheter in your abdomen (belly) for access.

During the treatment, the peritoneal cavity is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line the peritoneal cavity. Extra fluid and waste products are drawn out of the blood and into the dialysate.

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8
Q

What are the benefits of haemodialysis?

A

Allows for 4 treatment free days per week.

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9
Q

What are the disadvantages of haemodialysis?

A
  • need to visit center
  • strict dietary constraints
  • Needs arteriovenous fistula for access
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10
Q

What are the advantages of peritoneal dialysis?

A
  • Done at home
  • less constraint on food and water
  • Travel is much easier
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11
Q

What are the disadvantages of peritoneal dialysis?

A

Normally 7 days a week
chance of infection due to catheter or peritonitis

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12
Q

What are the three factors to consider when doing a live donor kidney transplant, to do with the kidney match?

A

Blood type compatibility
HLA typing
Serum cross matching

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13
Q

What are factors to consider when doing a live kidney donor transplant?

A

Age
Comorbidities
Kidney Match
Future Pregnancies
Mental Health History
Financial Stability
Family History

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14
Q

what happens to the native kidneys in kidney transplantation?

A

They are left in the abdomen if there is space

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15
Q

What are the food and water recommendations post transplant?

A

Low salt and sugar diet
No raw eggs or meat
Regular fluid intake
Not food items which can interact with tacrolimus (the immunosuppresant)

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16
Q

Which conditions are patients at risk of developing after a kidney transplant?

A

Diabetes - keep active lifestyle
CVD - measure B and manage accordingly
Cancer - regular checking of skin and breasts
Psychiatric - being mindful and seeking help

17
Q

What are some general recommendations post surgery?

A

No smoking
No NSAIDs
No drugs / alcohol
Flu Jabs
Immunosuppressants
Antibiotics

18
Q

Where are the three general stitches in a kidney transplant?

A

Between the donor and recipient arteries

Between donor and recipient veins

Between transplant’s ureter and recipient’s urinary bladder

19
Q

Why should the antecubital fossa and cephalic vein at wrist level be avoided when taking blood or inserting IV for patients with CKD?

A

For patients with CKD, you want to preserve this to allow dialysis in the future

20
Q

Why should transfusions be avoided in patients who can have transplants in the future?

A

If you are getting blood from a donor, you are exposed to the donor’s antigens

If you then get offered a kidney from another donor who shares similar antigens to those you have already been sensitised to, that gives you increased risk of transplant failure

21
Q

What are radionuclide studies used for?

A

Understanding donors to see the true renal function of those who are donating their kidneys

22
Q

What two measurements is risk of CKD risk classification based on?

A

ACR (albumin to creatinine ratio) and eGFR

23
Q

Describe how an infection can cause AKI?

A

Infection -> sepsis -> hypotension ->hypoperfusion -> AKI

BRS UROLOGY & RENAL (11 decks)

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