1B dialysis and kidney transplant

Question 1

Differentiate between AKI and CKD

Answer 1

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

Question 2

What are the causes of AKI?

Answer 2

• 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

Question 3

What are the causes of CKD?

Answer 3

• Diabetes
• HTN
• Infection
• Systemic diseases e.g. lupus
• Long term use of NSAIDS

Question 4

How dose HTN lead to CKD?

Answer 4

Thickening of arterial walls to withstand pressure—> narrow lumen—> decreased perfusion to kidney—> ischaemic injury to glomerulus—> immune cells secrete growth factors—> mesangial cells secrete ECM—> glomerulosclerosis, hardening and scarring—> kidney failure

Question 5

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

Answer 5

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

Adress hyperkalaemia

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

Potassium binders

Dialysis

Question 6

What are the different types of dialysis?

Answer 6

• Haemodialysis
• Peritoneal dialysis

Question 7

Describe haemodialysis

Answer 7

Dialysate isa 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

1. Your blood enters the dialyzer, where it is filtered.
2. Dialysate solution enters the dialyzer. It draws the waste out of your blood.
3. Used dialysate solution is pumped out of the machine and discarded.

Question 8

Describe peritoneal dialysis

Answer 8

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.

• 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.

Question 9

What are the pros and cons of haemodialysis?

Answer 9

Question 10

What are the pros and cons of peritoneal dialysis?

Answer 10

Question 11

What are factors needed to consider for a live kidney donor?

Answer 11

• Age
• Comorbidities
• Kidney match
• Future pregnancy
• Mental health history
• Financial stability
• Two healthy kidneys
• Family history of kidney disease

Question 12

How are kidneys matched?

Answer 12

• Blood type compatibility
• HLA typing
• Serum crossmatch

Question 12

What are the requirements for two healthy kidneys?

Answer 12

• Normal size (US)
• Normal function (GFR)
• No blood, protein in urine

Question 13

Describe what happens during a kidney transplantation and what happens to the native kidney

Answer 13

The original kidneys are not usually removed unless they are causing severe problems such asuncontrollable high blood pressure, frequent kidney infections, or are greatly enlarged.

Question 14

Outline recommendations for a patient who has undergone a kidney transplant surgery to lead to a healthy life while managing his condition

Answer 14