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Renal SB > Dialysis and Renal Transplantation > Flashcards

Dialysis and Renal Transplantation Flashcards

1
Q

what is the purpose of dialysis

A

removes toxins

  • urea
  • potassium
  • sodium

infusion of bicarbonate

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2
Q

how much dialysis does a patient need a week

A

4 hours

3 days a week

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3
Q

what are the restrictions put on patients on dialysis

A

Fluid
If anuric 1litre per day (including food based fluid)

Salt
Low salt diet to reduce thirst and help with fluid balance

Potassium
Low potassium diet.

Phosphate
Low phosphate diet
Phosphate binders with meals (6-12 pills per day)

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4
Q

what is the gold standard for dialysis access

A

fistula

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5
Q

what is a fistula

A

Joins an artery and a vein to make an enlarged thick walled vein called an Areteriovenous Fistula

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6
Q

what are the pros of a fistula

A

Good blood flow

Unlikely to cause infection

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7
Q

what are the cons of fistulas

A

Requires surgery
Requires maturation of about 6 weeks before can be used
Can limit blood flow to distal arm “steal”
Can block

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8
Q

what can be used instead of a fistula and what is it

A

Tunneled Venous Catheter

A catheter inserted into a large vein- Jugular, subclavian or femoral

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9
Q

what are pros of Tunnelled Venous Catheter

A

Easy to insert (usually)

Can be used immediately

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10
Q

what are the cons of tunnelled venous catheter

A

High risk of infection
Can cause damage to veins making placing replacements difficult
Become blocked

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11
Q

what can happen is a tunnelled venous catheter becomes infected

A

Endocarditis
Discitis
Death

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12
Q

Ix for tunnelled venous catheter infection

A

Blood Cultures
FBC and CRP
Exit site swab

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13
Q

Tx for tunnelled venous catheter infection

A

Antibiotics
- Vancomycin

Line removal or exchange

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14
Q

what are possible complications of dialysis

A

Fluid overload
Blood leaks
Loss of vascular access
Hypokalaemia and cardiac arrest

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15
Q

how does peritoneal dialysis work

A

Solute removal by diffusion of solutes across the peritoneal membrane.

Water removal by osmosis (water moving to equalise a concentration gradient) driven by high glucose concentration in dialysate fluid.

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16
Q

what are the two types of peritoneal dialysis

A

CAPD - Continous peritoneal dialysis

APD - automated peritoneal dialysis

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17
Q

what are possible complications in peritoneal dialysis

A

infection
- peritonitis or exit site infection

membrane failure
hernias

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18
Q

what bugs can cause infection in peritoneal dialysis

A 
Staphylococci
Streptococci
Diptheroids
E. Coli
Klebseilla
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19
Q

Tx for peritoneal dialysis infection

A

Culture PD Fluid

Intraperitoneal Antibiotics

20
Q

what happens in membrane failure

A

Inability to remove enough water so become fluid overloaded

Requires switch to Haemodialysis

21
Q

what causes hernias in peritoneal dialysis

A

Increased intraabdominal pressure

Requires hernia repair and smaller fill volumes

22
Q

what are metabolic complications seen in ESKD

Bone Mineral Metabolism

A

Phosphate retention
Low 1-25 Vit D
Hypocalcaemia
Raised PTH&raquo_space; takes calcium away from the bones. Osteomalacia

23
Q

what are metabolic complications seen in ESKD

Anaemia

A

Epo deficiency

Iron deficiency

24
Q

other complications seen in ESKD

A

Sodium and water retention

Accelerated CV disease

25
Q

what are the two ways to decide when to start dialysis

A

start based on bloods

start based on symptoms

26
Q

what is the criteria for starting dialysis based on bloods

A

Resistant Hyperkalaemia
GFR 45
Unresponsive acidosis

27
Q

what is the criteria for starting dialysis based on symptoms

A 
Fatigue
Itch
Unresponsive fluid overload
Nausea
Vomiting
Loss of appetite
28
Q

what blood group is compatible for all blood groups of recipients

A

O

29
Q

what are HLA and what do they do

A

cell surface proteins expressed on cells

activate the immune system

30
Q

what are the 3 important types of HLA in transplant

A

HLA A
HLA B
HLA DR

31
Q

why is HLA important

A

Donor Specific HLA Antibodies (Ab)
- A patient may have been exposed to a HLA Ag previously and formed Ab to this.
» This leads to rejection

32
Q

what are the different forms of transplant rejection

A

Hyperacute
Acute
Chronic

33
Q

what happens in hyper acute rejection

A

Due to +ve Xmatch (preformed antibodies to the Tx)
Unsalvageable
Remove kidney

34
Q

what happens in acute rejection

A

Usually early
T cell or B cell mediated response
Can be treated with increased immunosupression

35
Q

what happens in chronic rejection

A

Immunological and vascular deterioration of the Tx

36
Q

what are Calcineurin Inhibitors

A

immune suppressors

37
Q

how do Calcineurin Inhibitors work

A

Act by inhibiting activation of T helper cells

Reduce NK cells activation
Reduce Cytotoxic T cell activation

Decrease cytokine release so prevent B cell proliferation and antibody production

38
Q

side effects of Calcineurin Inhibitors

A

Renal Dysfunction,
Hypertension,
Diabetes,
Tremors

39
Q

how do Azathioprine and Mycophenolate work

A

Antimetabolites by blocking purine synthesis

Leads to suppression of proliferation of lymphocytes and B cells

40
Q

what are side effects of azathioprine

A

Leucopaenia,
Anaemia,
GI side effects

41
Q

what should never be given along side azathioprine

A

Allopurinol

42
Q

how do steroids work

A

Act non selectively to suppress activity of T cells and proliferation of B cells.

43
Q

what are indicates for suitability for transplantation

A

Patient should have reasonable life expectancy ( >5 years)

Well enough for an operation

44
Q

contraindications for surgery

A

Malignancy - current or previous within in 2 years

Untreated TB
Severe IHD
Severe airway disease
Acute vasculitis 
Severe PVD
45
Q

what is the surgery for renal transplant

A

Extraperitoneal procedure

- Stent inserted between ureter and bladder

46
Q

what are possible surgical complications

A 
Bleeding (arterial or venous)
Arterial Stenosis / Thrombosis
Venous stenosis / Thrombosis
Ureteric Stricture and hydronephrosis
Wound infection
47
Q

what drugs can cause a graft to be lost

A

Cyclosporine/ Tacrolimus toxicity

Renal SB (15 decks)

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