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Y2 RENAL > Dialysis and Transplantation > Flashcards

Dialysis and Transplantation Flashcards

1
Q

Which toxins can dialysis remove that build up in end-stage kidney disease?

A

Urea
Potassium
Sodium
Creatinine

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2
Q

Which ion can be infused using dialysis?

A

Bicarbonate

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3
Q

List the components of dialysate

A 
Pure water
Sodium
Bicarbonate
Potassium
Glucose
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4
Q

How is water removed from the body in dialysis?

A

Create negative pressure across membrane to suck water out (filtration)

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5
Q

Dialysis is very efficient. True/False?

A

False

Not very efficient; longer treatment equals better efficiency

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6
Q

What is the time schedule for haemodialysis?

A

4 hours, 3 times a week

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7
Q

How much fluid, salt, potassium and phosphate is allowed during dialysis?

A

Restrict fluid - 1 litre water a day
Low salt diet
Low potassium diet
Low phosphate diet and phosphate binders with meals

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8
Q

What is the gold standard for dialysis access?

A

Arteriovenous fistula, usually in arm joining brachial artery and cephalic vein

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9
Q

What are the drawbacks of an AV fistula?

A

Requires maturation of 6 weeks before use
Can limit blood flow to distal arm
Thrombosis/ stenosis
Creates a shunt

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10
Q

What is the alternative access for dialysis whilst the AV fistula is maturing?

A

Tunnelled venous catheter inserted into jugular/subclavian/femoral vein

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11
Q

What are the drawbacks of tunnelled venous catheters?

A

High risk of infection (usually SA endocarditis/ discitis)
Damage vein
Thrombosis/ stenosis

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12
Q

What can go wrong with dialysis?

A

Hypotension (underfilling of intravascular space due to removal of water)
Blood leaks
Reduced vascular access
Hyperkalaemia - cardiac arrest

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13
Q

What is the alternative to haemodialysis and how does it work?

A

Peritoneal dialysis
Use peritoneal membrane for diffusion of solutes, water removal by osmosis and glucose conc. in dialysate which drains into bag afterwards

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14
Q

What is the time schedule for peritoneal dialysis?

A

Continuous: 4 times a day
OR
Autonomous: Overnight (1 bag a day)

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15
Q

What is the advantage of peritoneal dialysis over haemodialysis?

A

Portable - less restrictive

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16
Q

What are the disadvantages of peritoneal dialysis?

A 
Infection (peritonitis/ exit site due to contamination and gut bacteria translocation)
Membrane failure (can't remove water causing fluid overload)
Hernias (increased intrabdominal pressure)
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17
Q

When is dialysis started based on bloods?

A

Resistant hyperkalaemia
GFR less than 5 (following preparation!)
Unresponsive acidosis
Uraemia (UR >40)

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18
Q

Which syndrome can result in the short-term following haemodialysis?

A

Disequilibrium syndrome involving cerebral oedema and seizures

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19
Q

In end-stage kidney disease, survival with dialysis decreases with increasing age. True/False?

A

True

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20
Q

Kidney is taken out in transplant. True/False?

A

False

Leave kidneys and put new kidney in lower iliac fossa/pelvis

21
Q

Which donor blood groups are compatible with recipient with blood group O?

A

O

22
Q

Which donor blood groups are compatible with recipient with blood group A?

A

O

A

23
Q

Which donor blood groups are compatible with recipient with blood group B?

A

O

B

24
Q

Which donor blood groups are compatible with recipient with blood group AB?

A

O

AB

25
Q

People with blood group O have which antibodies? What is the effect of this?

A

Anti-A and anti-B antibodies, so can only receive donor from person with blood group O

26
Q

What are HLA proteins? List the main types

A

Cell surface proteins that activate the immune system in graft rejection
HLA A, B and DR

27
Q

Which HLA are class 1?

A

HLA A

HLA B

28
Q

Which HLA are class 2?

A

HLA DR

29
Q

1 HLA is inherited from each parent. True/False?

A

True

30
Q

A patient who has been exposed to non-self HLA Ag forms antibody to it and this leads to rejection. What are the main ways HLA Ag exposure can occur?

A

Blood transfusion
Pregnancy
Previous transplants

31
Q

Outline the process of graft rejection

A

HLA antigen binds to dendritic cell which expresses MHCII that activates CD4 cells, which enable B cell proliferation (produce antibodies to graft) and CD8/NK production which directly attack graft

32
Q

Describe the 3 forms of graft rejection

A

Hyperacute: preformed Ab to transplant, minutes (black kidneys)
Acute: T/B-cell mediated, early on
Chronic: immune/vascular deterioration of transplant

33
Q

Acute graft rejection may be treatable with immunosuppression. List some medication

A

Steroids
MMF
Cyclosporin
Tacrolimus

34
Q

Which class of drug includes cyclosporin and tacrolimus? How do they work?

A

Calcineurin inhibors

Inhibit activation of CD4 cells (thus reduce NK/CD8/B-cell proliferation)

35
Q

List some side effects of calcineurin inhibitors

A 
Renal dysfunction
Hypertension
Diabetes
Tremors
Drug interactions
36
Q

How do azathioprine and mycophenolate help in immunosuppression?

A

Block purine synthesis - suppress proliferation of B and T cells
Can cause leucopenia, GI upset, anaemia

37
Q

Which drug does azathioprine notably, infamously, dangerously interact with?

A

Allopurinol

38
Q

List the main types of donor kidney

A

Brain dead patient
Cardiac dead patient
Live donor (familial)
Kidney-pancreas dual transplant (diabetics)

39
Q

Allocation of kidneys in UK is based on tissue typing and then time on donor list. True/False?

A

True

40
Q

List absolute contraindications to transplantation of kidney

A 
Malignancy (active or within last 2-5 years)
Active HCV/ HIV
Untreated TB
Severe IHD/ airway disease/ PVD
Active vasculitis
Hostile bladder
41
Q

List people at risk of progression to dialysis

A 
Inheritable renal conditions
CKD/AKI
CVD/ hypertension
Proteinuria
Diabetes
Smoking
Chronic NSAID use
Untreated UT obstruction
42
Q

What are the 3 key principles of dialysis?

A

DIFFUSION: movement of solutes from high to low conc.
CONVECTION: movement of water in response to pressure gradient (ultrafilitration)
ADSORPTION: plasma proteins to membrane and absorb protein-bound solutes

43
Q

What is the difference between haemodialysis and haemodiafiltration?

A

Increased connective force, increased volume of pressure driven ultrafiltrate (SOLUTE DRAG)

44
Q

How do you explain haemodialysis to a patient?

A

Insert fistula to act as an artifical kidney putting good things in (nutrients, vitamins) and taking waste out, involves minor procedure

45
Q

How do you explain peritoneal dialysis to a patient?

A

Insert tube into tummy which connects to a machine overnight - puts fluid in which is left for a few hours and drained - can do it at home, giving patients more freedom

46
Q

How long after transplantation does a patient get the survival benefit?

A

3 months

47
Q

List complications of renal transplantation

A 
Bleeding
Arterial or venous stenosis
Wound infection
Lymphocele
Ureteric stricture
48
Q

State the main side effect of immunosuppression and list types

A

Bacterial (UTI/ URTI)
Prophylaxis for PCP
Fungal
Viral (CMV, HSV, BK)

Y2 RENAL (17 decks)

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