Dialysis and kidney transplant Flashcards
Causes of ckd
Hypertension - leads to glomerular fibrosis and dehydration
Long term ibuprofen - blockage of renal blood flow .: chronic interstitial nephritis
Gastroenteritis - advanced glycation end prods from superoxide - AKI
E.Coli infection leading to diarrhoea
Treatments for CKD
Sodium bicarbonate
Stop NSAIDs
IV fluids to rehydrate possible resus
electrolyte management w/ K binders
Types of dialysis
Haemodialysis
Peritoneal dialysis
How does haemodialysis work
outside the body
Blood from patient’s venous supply enters dialyser through a semipermeable membrane to exchange nutrients and waste products with dialysate (fluid) and then re enters patient’s arterial supply
How does peritoneal dialysis work
within the body
Fresh dialysate injected into peritoneal cavity using catheter for a few hours, then removed from body
What are the advantages of peritoneal dialysis?
Performed at home,
lesser constraints on diet,
portable device
What are the disadvantages of peritoneal dialysis?
7 days a week usually
Chance of infection due to catheter - peritonitis
Risk of peritoneal scarring
Factors for determining candidate as suitable live kidney donor
Age
Fitness
Comorbidities
matching blood type
FH
Mental health history
Kidney function/size
Recommendations post kidney transplant
smoking cessation
healthy eating
immunosuppression
flu jabs
avoid alcohol
watch bp
What are the advantages of haemodialysis?
3-4 hours of treatment 3 days a week (4 days a week off), no permanent manipulation of body
What are the disadvantages of haemodialysis?
Usually need to visit a dialysis centre,
strict dietary constraints,
needs access to bloodstream, can take up to 3mths
contraindicated with future transplants as it reduces urine output over time and dehydrates kidneys
Risk of bacteraemia with central venous line option
Which bloodstream access sites are typically used in haemodialysis?
Arteriovenous fistula or tunnelled central venous line
Where are kidneys usually transplanted and anastamosed to?
Iliac fossa - onto common iliac artery and vein and ureter straight into bladder. Native kidneys often left in there
What immunosuppressant is given?
Tacrolimus
