2 Renal replacement therapy

Question 1

What are the different renal function

Answer 1

• excretory
• water and electrolyte balance
• acid base balance
• renal endocrine function (EPO, calcium metabolism, renin secretion)

Question 2

Is renal dialysis acitve or passive

Answer 2

passive

Question 3

is renal dialysis a true renal replacement?

Answer 3

no, significant lifesyle restrictions remain

Question 4

What kind of restrictions are a part of having dialysis

Answer 4

• only allows you to make changes when hooked up to the machine
• up, down, up, down = affects quality of life
• restricted in what food/ drink they can have

Question 5

what are the two types of dialysis called

Answer 5

• haemodialysis (outside the body)

- periotoneal dialysis (inside the body)

Question 6

how does haemodialysis happen

Answer 6

• blood pumped from the arteriovenous fisula into a dialyzer
• in the dialyzer, waste products filter from the blood through an artificial membrane into a fluid called the dialysate
• purified blood is pumped from the dialyzer into the arteriovenous fisula

Question 7

what is given to stop blood clotting in haemodialysis

Answer 7

heparin (anti-coagulant)

Question 8

how does peritoneal dialysis happen

Answer 8

• connect to catheter
• drain out from patient
• fill abdomen
  disconnect
  (works in the same way as haemodialysis but using the body as sac)

Question 9

What are the advantages of peritoneal dialysis regimens

Answer 9

• can do day and night
• can do it overnight
• lots of patterns people use
• can do it at home so can do it any day
• more portable/ user friendly

Question 10

disadvantage of peritoneal dialysis

Answer 10

people are in charge of their own life/death

Question 11

How are renal endocrine functions replaced

Answer 11

1. EPO
   - replaced by EPO injections
   - maintains red cell mass
2. Bone mass maintenance
   - vit D supplementation
   - osteoporosis prevention programme
3. Hypertension control
   - renin-angiotensin system inactive

Question 12

What are the advantages of renal transplantation

Answer 12

• optimal treatment for ESRD
• normal renal function
• no dietary restrictions
• normal energy and fertility
• HLA matched (may be family)

Question 13

What are the issues for transplanting kidneys

Answer 13

Generally:

• rejection
• immunosuppression
• high cardiovascular mortality
• osteoporosis risk

Children:

• won’t pass through puberty properly
• can’t support growth

Adults:

• as you get older become less of a priority for transplantation
• each kidney only lasts about 10 years

Question 14

why are kidney transplants and osteoporosis linked

Answer 14

greater bone loss the more time it’s been since your transplant

Question 15

how does whether the donor was alive or dead affect graft survival

Answer 15

kidney from an alive person lasts longer

Question 16

How is dentistry affected by someone having renal dialysis

Answer 16

• treat AFTER haemodialysis sessions (and not on the day they have it as will have taken anti-coagulant)
• liase with physicians for drugs
• do not use the dialysis arm (‘shunt’)
• only do what needs to be done while they are on dialysis

Question 17

How is denstistry affected by someone who has had a renal transplant

Answer 17

• initially normal renal function
• may reduce with time (check creatinine levels)
• complications are those of immune suppressants

drug interactions and complications:

• prednisolone, azathioprine, tacrolimus, cyclosporin
• steroid side effects
• increased cancer risk