Dialysis

Question 1

List 3 features of diabetic nephropathy

Answer 1

HTN
Progressively increasing proteinuria
Progressively deteriorating kidney function

Question 2

List consequences of renal failure

Answer 2

Increases : morbidity, mortality, CHF, MI, stroke and PVD

Question 3

What is the range of microalbuminurea?

Answer 3

30-300mg/24hrs

Question 4

What is the management for diabetic nephropathy?

Answer 4

BGC control
HTN control
Inhibiting RAAS with ACEi
Stop smoking

Question 5

When can you not use an ACEi and why?

Answer 5

Renal artery stenosis - will cause huge drop in GFR

Question 6

List 6 indications of renal failure

Answer 6

Hyperkalaemia / hypomnatreamia 
Acidosis 
Fluid retention 
Dont secrete VitD
Symptoms 
Anaemia and renal bone disease

Question 7

List symptoms of renal failure

Answer 7

Tiredness, loss of appetite, SoB, oedema, nocturia, pruritus, cold, twitchy, nausea, loss of taste or nasty taste, weight loss

Question 8

List complications of renal failure if treatment withheld

Answer 8

Hyperkalaemia leading to arrhythmia and MI
Pulmonary oedema
N&V - cachexia
Fits / coma / death

Question 9

When should discussions about renal replacement therapy begin?

Answer 9

eGFR < 20

Question 10

What are the benefits of dialysis?

Answer 10

Improve uraemia Sx, correct fluid balance, avoid life threatening events

Question 11

What are risks of dialysis?

Answer 11

Infection, hypotension, arrhythmia, access related, negative effect on QoL

Question 12

Name the 2 types of dialysis

Answer 12

Haemodialysis and peritoneal dialysis

Question 13

List features of haemodialysis

Answer 13

In hospital, 4hrs, 3/7, need fistula

Limits work / travel

Question 14

List features of peritoneal dialysis

Answer 14

Home based, daily and continuous, less harm-dynamic stress, technique limited, easier to travel / work

Question 15

List benefits of transplantation

Answer 15

Better renal replacement 
Better anaemia 
Costs less
Long survival 
Better QoL

Question 16

List risks of transplantation

Answer 16

Immunosuppression
Not curative
Worse when it fails
Not for old / sick

Question 17

What factors must you consider before commencing dialysis in an elderly person?

Answer 17

The patient’s wishes unless they lack capacity
Multiple comorbidities
Poor nourishment
Social isoaltion - will need social support
Lower physical and cognitive function

Question 18

What is conservative care?

Answer 18

Non dialysis path chosen by pt to manage Sx