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Y2 Revision > 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 stuck water out (filtration)

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5
Q

true or false: dialysis is very efficient

A

false

not very efficient, longer treatment improves this

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6
Q

what is the time schedule for haemodialysis?

A

four hours, three times a week

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7
Q

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

A

1 litre of water a day
low salt diet
low potassium diet
low phosphate diet

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8
Q

what is the gold standard for dialysis access?

A

arteriovenous fistula, usually in the arm

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9
Q

what are the drawbacks of an AV fistula?

A

requires maturation of 3-6 months before use

can limit blood flow to distal arm

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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 the jugular, subclavian or femoral vein

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11
Q

what are the drawbacks of tunnelled venous catheters?

A

high risk of infection

damage to the vein

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12
Q

what can go wrong with dialysis?

A

fluid overload/oedema
blood leaks
hypokalaemia, can cause 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 entering dialysate fluid in the abdomen, which drains into the bag afterwards

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14
Q

what is the time schedule for peritoneal dialysis?

A

four times a day

or

overnight (one bag a day)

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15
Q

what is the advantage of peritoneal dialysis over haemodialysis?

A

portable so less restrictive

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16
Q

what are the disadvantages of peritoneal dialysis?

A

infection
membrane failure
hernias

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17
Q

when is dialysis started based on bloods?

A

resistant hyperkalaemia
GFR less than 5 following preparation
unresponsive acidosis

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18
Q

which syndrome can result in the short term following haemodialysis?

A

disequilibrium syndrome involving cerebral oedema and seizures

19
Q

true or false: in end stage kidney disease, survival with dialysis decreases with increasing age

A

true

20
Q

true or false: the kidney is taken out in transplant

A

false

leave the kidneys and put a new kidney in the lower iliac fossa/pelvis

21
Q

which donor blood groups are compatible with recipients with blood group O?

A

O

22
Q

which donor blood groups are compatible with recipients with blood group A?

A

O

A

23
Q

which donor blood groups are compatible with recipients with blood group B?

A

O

B

24
Q

which donor blood groups are compatible with recipients with blood group AB?

A

O

AB

25
Q

people with blood group O have which antibodies and what does this mean?

A

anti-A and anti-B antibodies

can only receive donor blood from people with blood group O

26
Q

what are HLA proteins?

A

cell surface proteins that activate the immune system in graft rejection

27
Q

name the main types of HLA proteins

A

HLA A
HLA B
HLA DR

28
Q

which HLA are class 1?

A

HLA A

HLA B

29
Q

which HLA are class 2?

A

HLA DR

30
Q

true or false: one HLA is inherited from each parent

A

true

31
Q

what are the main ways HLA antigen exposure can occur?

A

blood transfusion
pregnancy
previous transplants

32
Q

name the three forms of graft rejection

A

hyperacute
acute
chronic

33
Q

describe hyperacute graft rejection

A

preformed antibodies to transplant

takes minutes

34
Q

describe acute graft rejection

A

T or B cell mediated

occurs early on

35
Q

describe chronic graft rejection

A

immune/vascular deterioration of transplant

36
Q

list some medication that can treat acute graft rejection

A

steroids
MMF
cyclosporin
tacrolimus

37
Q

which class of drug induces cyclosporin and tacrolimus?

A

calcineurin inhibitors

38
Q

how do calcineurin inhibitors work?

A

inhibit activation of CD4 cells

39
Q

list some side effects of calcineurin inhibitors

A 
renal dysfunction
hypertension
diabetes
tremors 
drug interactions
40
Q

how do azathioprine and mycophenolate help in immunosuppression?

A

block purine synthesis - suppress proliferation of B and T cells

can cause oversuppression

41
Q

which drug does azathioprine interact dangerously with?

A

allopurinol

42
Q

list the main types of donor kidney

A

brain dead patient
cardiac dead patient
live donor (familial)
kidney pancreas dual transplant (diabetics)

43
Q

true or false: allocation of kidneys in the UK is based on tissue typing and then time on the donor list

A

true

44
Q

list absolute contraindications to transplantation of a kidney

A 
malignancy 
untreated TB
severe IHD 
severe airway disease
active vasculitis

Y2 Revision (95 decks)

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