Dialysis and Transplantation Flashcards
which toxins can dialysis remove that build up in end stage kidney disease?
urea
potassium
sodium
creatinine
which ion can be infused using dialysis?
bicarbonate
list the components of dialysate
pure water sodium bicarbonate potassium glucose
how is water removed from the body in dialysis?
create negative pressure across membrane to stuck water out (filtration)
true or false: dialysis is very efficient
false
not very efficient, longer treatment improves this
what is the time schedule for haemodialysis?
four hours, three times a week
how much fluid, salt, potassium and phosphate is allowed during dialysis?
1 litre of water a day
low salt diet
low potassium diet
low phosphate diet
what is the gold standard for dialysis access?
arteriovenous fistula, usually in the arm
what are the drawbacks of an AV fistula?
requires maturation of 3-6 months before use
can limit blood flow to distal arm
what is the alternative access for dialysis whilst the AV fistula is maturing?
tunnelled venous catheter inserted into the jugular, subclavian or femoral vein
what are the drawbacks of tunnelled venous catheters?
high risk of infection
damage to the vein
what can go wrong with dialysis?
fluid overload/oedema
blood leaks
hypokalaemia, can cause cardiac arrest
what is the alternative to haemodialysis and how does it work?
peritoneal dialysis
use peritoneal membrane for diffusion of entering dialysate fluid in the abdomen, which drains into the bag afterwards
what is the time schedule for peritoneal dialysis?
four times a day
or
overnight (one bag a day)
what is the advantage of peritoneal dialysis over haemodialysis?
portable so less restrictive
what are the disadvantages of peritoneal dialysis?
infection
membrane failure
hernias
when is dialysis started based on bloods?
resistant hyperkalaemia
GFR less than 5 following preparation
unresponsive acidosis
which syndrome can result in the short term following haemodialysis?
disequilibrium syndrome involving cerebral oedema and seizures
true or false: in end stage kidney disease, survival with dialysis decreases with increasing age
true
true or false: the kidney is taken out in transplant
false
leave the kidneys and put a new kidney in the lower iliac fossa/pelvis
which donor blood groups are compatible with recipients with blood group O?
O
which donor blood groups are compatible with recipients with blood group A?
O
A
which donor blood groups are compatible with recipients with blood group B?
O
B
which donor blood groups are compatible with recipients with blood group AB?
O
AB
people with blood group O have which antibodies and what does this mean?
anti-A and anti-B antibodies
can only receive donor blood from people with blood group O
what are HLA proteins?
cell surface proteins that activate the immune system in graft rejection
name the main types of HLA proteins
HLA A
HLA B
HLA DR
which HLA are class 1?
HLA A
HLA B
which HLA are class 2?
HLA DR
true or false: one HLA is inherited from each parent
true
what are the main ways HLA antigen exposure can occur?
blood transfusion
pregnancy
previous transplants
name the three forms of graft rejection
hyperacute
acute
chronic
describe hyperacute graft rejection
preformed antibodies to transplant
takes minutes
describe acute graft rejection
T or B cell mediated
occurs early on
describe chronic graft rejection
immune/vascular deterioration of transplant
list some medication that can treat acute graft rejection
steroids
MMF
cyclosporin
tacrolimus
which class of drug induces cyclosporin and tacrolimus?
calcineurin inhibitors
how do calcineurin inhibitors work?
inhibit activation of CD4 cells
list some side effects of calcineurin inhibitors
renal dysfunction hypertension diabetes tremors drug interactions
how do azathioprine and mycophenolate help in immunosuppression?
block purine synthesis - suppress proliferation of B and T cells
can cause oversuppression
which drug does azathioprine interact dangerously with?
allopurinol
list the main types of donor kidney
brain dead patient
cardiac dead patient
live donor (familial)
kidney pancreas dual transplant (diabetics)
true or false: allocation of kidneys in the UK is based on tissue typing and then time on the donor list
true
list absolute contraindications to transplantation of a kidney
malignancy untreated TB severe IHD severe airway disease active vasculitis
