Dialysis Flashcards
What does AKI stand for
acute kidney injury
What is meant by prerenal
Anything that means reduced blood flow/ reduced subtrate for the kidney
What is meant by intrinsic renal disease
A disease within the kidney iteself
What is post renal disease
Anything after the kidney
What is meant by the STOP mneumonic used for finding the cause of aki
S=sepsis and hypoperfusion (pre kidney)
Toxicity= intrinsic
Obstruction= post
Primary= intrinsic
In which 5 areas are the abnormalities
Salt Water Electrolytes Acidosis Toxins
How do patients with AKI present
- Acutely unwell
- Hypertensive and oliguric
How do patients with AKI’s kidneys appear on imaing
Normal sized
How is chronic renal failure different to acute?
As well as abnormalities in SWEAT, hormone abnormalities
How do nephrons appear/ act in chronic renal failure
Injured neurons replaced with fibrosis
Normal nephrons gradually fail due to hyperfiltration
How does urine differ in chronic renal failure than to a healthy person
Normal urine output as scarring is usually tubular
Urine quality reduced
What are the variables of the MDRD equation?
Creatinine concentration
Age
Sex
Race
When is renal replacement therapy begun
When symptomatic: GFR 5-10ml
What should be the ideal option for patients with chronic kidney disease
Transplatation
What are the principles of dialysis
Exchange of solutes and fluids across a membrane (diffusion, convection)
What is meant by convection
Either have lower pressure or lower osmotic load on other side of membrane, causing solutes to cross
What is peritoneal dialysis
Artificial tube that enters through abdominal wall and travels through a subcutaneous
How is infection avoided with peritoneal dialysis
- Longer subcutaneous tract means that bacteria is less likely to travel down
- Cuffs at each end form a seal to prevent movement of bacteria
What diffuses across the membrane in peritoneal dialysis
Potassium Urea Water Creatinine H+ ions
What can be used to draw water across the peritoneal membrane
Glucose
Buffers- given to the patient
HC03-/ lactate in high concentration
What is done when the concentration gradients even out over time
Drain the fluid
Start ahain
What are the complications of peritoneal dialysis
Peritonitis
Loss of membrane function
Advantages of peritoneal dialysis
Continuous, indepdence
Less demanding on the heart
Assisted APD
Disadvantages of peritoneal dialysis
Depends on patient competence
Membrane eventually fails (most patients only on it 3-5 years)
What is the principle of haemodialysis
Blood flows through tubes and fluid/ diasylate flows in opposite direction around the tubes
Solutes diffuse out
Pros of haemodialysis
Hospital or home based
Efficient
Cons of haemodialysis
Access to circulation
Limited by staff and space
Complications of haemodialysis
Access complication: thrombosis, infections, lack of access
