7. Renal Dialysis and transplant

Question 1

Why would a patient be started on dialysis?

Answer 1

Inability to control volume status including pulmonary oedema 
Inability to control blood pressure 
Serositis
Acid base or electrolyte imbalance 
Pruritus
N/V/detorioration in nutrional status
Cognitive impairment

Question 2

What are the different methods of renal dialysis?

Answer 2

Haemodialysis- blood is passed over a semi-permeable membrane with dialysate being pumped the other way

Peritoneal dialysis- the peritoneum is used a semipermeable membrane

Haemofiltration- blood is replaced by water in a high pressure gradient. Useful in low blood pressure situations

Question 3

What is a fistula?

What is important to remember?

Answer 3

A anastomoses between an artery and a vein

Don’t compress above it, may lead to thrombosis in the fistula (no BP, no blood taken)

Question 4

What are the complications of dialysis?

Answer 4

Caddiovascular Disease 
Protein-calorie malnutrition 
Renal bone disease
Infection
Amyloid deposits-carpal tunnel, arthralgia

Question 5

What are the contraindications to a transplant

Answer 5

Cancer with mets
Infection, HIV, unstable CVD
Congestive heart failure, CVD

Question 6

What are the best types of donors?

What are the other types of donors?

Answer 6

Live donors?

Deceased donors:
Brain dead
Expanded criteria donor
Donor after cardiac death

Question 7

What are the various immunosuppresion drugs used in transplants?

Answer 7

Monoclonal antibodies- block activated T cells by CD-25

Calcineurin inhibitors- tacrolimus, ciclosporin (block T cell proliferation’s)

Antimetabolites-

Glucortisteroids- decreased inflammatory cytokines

Question 8

What are the complications of a transplant?

Answer 8

Surgical- bleed, thrombosis, infection, urinary leaks, lymphocyte, hernia

Delayed graft function- affects up to 40% of grafts

Rejection

Infection

Malignancy

CVD