Dialysis and renal transplant

Question 1

What is dialysis?

Answer 1

Filters the blood artificially in end stage renal failure (eGFR 5-10) or in complications of renal failure. Removes excess fluid, solutes, + waste products.

Question 2

Acute dialysis indications = AEIOU (5)

Answer 2

Acidosis (severe + unresponsive), 
Electrolyte abnormalities (hyperkalaemia), 
Intoxication (overdose of some drugs), 
pulmonary Oedema (Severe + unresponsive), 
Uraemia -seizures/ encephalopathy.

Question 3

Long term dialysis indications (2)

Answer 3

End stage renal failure.

Acute indications that become long term.

Question 4

Explain peritoneal dialysis (3)

Answer 4

Peritoneum is semi-permeable membrane. Dialysis solution (contains dextrose) added to peritoneal space via catheter.
Ultrafiltration occurs from blood, across the peritoneal membrane, into dialysis solution (contains dextrose + in peritoneal space).
The dialysis solution replaced, removing the waste products filtered from the blood.

Question 5

What is Tenckhoff catheter?

Answer 5

Plastic tube inserted into peritoneal cavity, used to add + remove fluid

Question 6

What is continuous ambulatory peritoneal dialysis?

Answer 6

Dialysis solution in peritoneum all the time + changed 4x in day.

Question 7

What is automated dialysis peritoneal dialysis?

Answer 7

Machine replaces fluid overnight (8-10hrs)

Question 8

Complications of peritoneal dialysis? (5)

Answer 8

Bacterial peritonitis.
Peritoneal sclerosis.
Ultrafiltration failure (start to absorb dextrose solution, thus ↓es filtration gradient).
Weight gain (absorb carbs from dialysis fluid). Psychosocial effects.

Question 9

What is heamodialysis?

Answer 9

Blood filtered by machine.

Blood passes over semi=permeable membrane with dialysis fluid on other side.

Question 10

What are 2 accesses for heamodialysis?

Answer 10

Tunnelled cuffed catheter

A-V fistula

Question 11

What is tunnelled cuffed catheter? and 2 complications?

Answer 11

Tube inserted into subclavian/ jugular vein and tip sits in superior vena cava. 2 lumens – blood can exit body (Red) and blood enters the body (blue).
Dacron cuff = surrounds catheter. Promotes healing + adhesion of tissue to cuff.
Complications = infections + blood clots.

Question 12

What is A-V fistula?

Answer 12

Artificial connection between artery + vein. Allows blood to flow under ↑pressure from artery into vein.
Surgical operation, 4 wk-mnth maturation period.

Question 13

Name 3 sites for AV fistula?

Answer 13

Radio-cephalic,
Brachio-cephalic,
Brachio-basilic.

Question 14

A-V fistula examination includes? (4)

Answer 14

skin integrity,
aneurysms,
palpable thrill,
machinery murmu

Question 15

Complications of A-V fistula

Answer 15

Aneurysm. 
Infection. 
Thrombosis. 
Stenosis. 
STEAL syndrome 
High output heart failure

Question 16

What is STEAL syndrome?

Answer 16

Fistula steals blood from distal limb causing distal ischaemia

Question 17

Why does A-V fistula cause high output heart failure?

Answer 17

Blood flows quickly from arterial to venous system, thus returns quickly to heart + increases preload = leads to hypertrophy + heart failure

Question 18

What is donor matching in renal transplant?

Answer 18

Based on human leucocyte antigen type A, B, + C on chromosome 6. Don’t need to be exact match

Question 19

Procedure for renal transplant?

Answer 19

Pts kidneys left in place. Donor kidney’s blood vessels anastomosed with external iliac vessels, AND ureter directly anastomosed to bladder.

Question 20

Post-renal transplant immunosuppression Tx? (3)

Answer 20

Need lifelong immunosuppression to ↓risk of rejection:
Tacrolimus,
mycophenolate,
prednisolone.

Question 21

Complications from transplant:

Answer 21

Transplant rejection.
Transplant failure.
Electrolyte imbalance.

Question 22

Complications from immunosuppression: (5)

Answer 22

IHD. 
T2DM. 
Infections with unusual MO. 
Non-Hodgkin lymphoma. 
Skin cancer.