Dialysis and renal transplant Flashcards
What is dialysis?
Filters the blood artificially in end stage renal failure (eGFR 5-10) or in complications of renal failure. Removes excess fluid, solutes, + waste products.
Acute dialysis indications = AEIOU (5)
Acidosis (severe + unresponsive), Electrolyte abnormalities (hyperkalaemia), Intoxication (overdose of some drugs), pulmonary Oedema (Severe + unresponsive), Uraemia -seizures/ encephalopathy.
Long term dialysis indications (2)
End stage renal failure.
Acute indications that become long term.
Explain peritoneal dialysis (3)
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.
What is Tenckhoff catheter?
Plastic tube inserted into peritoneal cavity, used to add + remove fluid
What is continuous ambulatory peritoneal dialysis?
Dialysis solution in peritoneum all the time + changed 4x in day.
What is automated dialysis peritoneal dialysis?
Machine replaces fluid overnight (8-10hrs)
Complications of peritoneal dialysis? (5)
Bacterial peritonitis.
Peritoneal sclerosis.
Ultrafiltration failure (start to absorb dextrose solution, thus ↓es filtration gradient).
Weight gain (absorb carbs from dialysis fluid). Psychosocial effects.
What is heamodialysis?
Blood filtered by machine.
Blood passes over semi=permeable membrane with dialysis fluid on other side.
What are 2 accesses for heamodialysis?
Tunnelled cuffed catheter
A-V fistula
What is tunnelled cuffed catheter? and 2 complications?
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.
What is A-V fistula?
Artificial connection between artery + vein. Allows blood to flow under ↑pressure from artery into vein.
Surgical operation, 4 wk-mnth maturation period.
Name 3 sites for AV fistula?
Radio-cephalic,
Brachio-cephalic,
Brachio-basilic.
A-V fistula examination includes? (4)
skin integrity,
aneurysms,
palpable thrill,
machinery murmu
Complications of A-V fistula
Aneurysm. Infection. Thrombosis. Stenosis. STEAL syndrome High output heart failure
What is STEAL syndrome?
Fistula steals blood from distal limb causing distal ischaemia
Why does A-V fistula cause high output heart failure?
Blood flows quickly from arterial to venous system, thus returns quickly to heart + increases preload = leads to hypertrophy + heart failure
What is donor matching in renal transplant?
Based on human leucocyte antigen type A, B, + C on chromosome 6. Don’t need to be exact match
Procedure for renal transplant?
Pts kidneys left in place. Donor kidney’s blood vessels anastomosed with external iliac vessels, AND ureter directly anastomosed to bladder.
Post-renal transplant immunosuppression Tx? (3)
Need lifelong immunosuppression to ↓risk of rejection:
Tacrolimus,
mycophenolate,
prednisolone.
Complications from transplant:
Transplant rejection.
Transplant failure.
Electrolyte imbalance.
Complications from immunosuppression: (5)
IHD. T2DM. Infections with unusual MO. Non-Hodgkin lymphoma. Skin cancer.
