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Technology > Dialysis/transplant/renal function > Flashcards

Dialysis/transplant/renal function Flashcards

1
Q

types of donor 2

A

living
cadaveric

living include
related
directed
altruistic

cadaveric
DCD
DBD

DCD can further be categorised via Maastricht classification which describes mode cardiac arrest

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2
Q

extended criteria donors

A 
DBD donars
more than 60
and 50-59 with 2 of 
hypertension
terminal creatinine >133
cerebrovascular cause of death

extended criteria to increase pool for recipients

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3
Q

contraindications to being a living renal donor 7 absolute

A 
absolute
pregnancy
single kidneys
sig below age related gfr cut off
active untreated malignancy
morbid obesity >40
uncontrolled disease process that will impact renal fuction
under 18
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4
Q

how are organs preserved

A

cooling by perfusion cold perfusate
ice

perservation fluid
aim reduce risk cellular degradation due to low oxygen situation

soltran

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5
Q

soltran solution 4 MMCC

A

pot citrate
mannitol
mag sulphate
sod citrate

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6
Q

other perfusates

A

UW Belzer
collins
marshalls

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7
Q

why use right iliac fossa

A 
vessels more superficial than left
rutherford morrison incision
ep approach
do vein first
may use internal iliac or common
RA end to side to EIA or end to end to IIA
RV end to side to EIV, CIV
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8
Q

ureterocystostomy

A

can be onlay or tunnelled

donor ureter kept as short as possible with periureteric fat preserved

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9
Q

what is GFR

A

describes flow rate of fluid through the nephrons and is one of the ways to measure kidney function

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10
Q

how can gfr be measured

A

using clearance of a substance from plasma or estimate from plasma creatinine using formula

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11
Q

creatinine overestimation gfr

A

as 10% secreted by kidney

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12
Q

formula to calculate gfr

A

cockcroft gault and MDRD

Cockcroft-Gault CrCl, mL/min = (140 – age) × (weight, kg) × (0.85 if female) / (72 × Cr)

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13
Q

formal measurement GFR

A

Cr 51 EDTA most accurate
DPTA can be used but slightly secreted
single infection Cr51 EDTA given
then measure blood levels at specified intervals 2-5 hours after injection to demonstrate decay curve
slope intercept method to calculate clearance
GFR normalised to BSA

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14
Q

MDRD vs cockcroft gault

A

CG estimates creatinine clearance, used for drug dosing

MDRD for those with impaired function, calulates GFR per BSA, not creatinine clearance

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15
Q

classification CKD

A 
based on GFR into five main groups
>90 = 1
60-90 = 2
45-60 = 3a
30-45 =3b
15-30 =4
less than 15 = 5
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16
Q

options for patient with ESRD 3

A

peritoneal dialysis /haemodialysis
transplant
no RRT

leading to certain death average 10-90 days

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17
Q

dialysis options

A

Continuous renal replacement thearpy
haemodialysis
peritoneal dialysis

18
Q

options continuous RRT

A 
CVVH
CVVHD
CVVHDF
SCUF - slow continuous ultrafiltration
CAVHD
19
Q

haemodialysis options

A

in centre HD 3 x a week

home HD short daily nocturnal

20
Q

peritoneal dialysis options

A

manual CAPD

cycler APD

21
Q

peritoneal dialysis options

A

manual CAPD

cycler APD

22
Q

indications acute dialysis 5

A 
fluid overload unresponsive diuretics
severe hyperkalaemia more than 6.5
severe met acidosis less than 7.1
uraemic symptoms >30 mmol/l
drug overdose dialysable toxin
23
Q

what is difference between HD and CVVH

A

Haemodilaysis is diffusive process using a semi-permeable membrane and a counter current flow (contraflow) system to maintain a waste solute concentration which is always lower on the dialysate side of the membrane. The gradient persists along the entire length of the membrane.
second principle ultrafiltration caused by convective flow of solutes and liquids

CVVH is continuous veno-venous haemofiltration. This involves Filtration and fluid replacement. Runs continuously. Takes much longer than HD, but better tolerated cardiovascularly. Therefore useful in ITU and in CVS patients”.
no dialysate
relies on hydrostatic pressure alone to produce ultrafilatration
fluid replaced either before or after ultrafiltration
more haemodynamic stability

24
Q

diffusion vs convection in HD vs HF

A

HD there is concentration gradient between blood and dialysate which allows diffusion of waste production
the driving force is the concetration gradient

haemofiltration
the driving force is the transmembrane pressure
movement due to convection between blood and fitlrate

25
Q

HD circuit components

A 
A arm
B Blood pump
C anti coagulant
D dialyser
E air dectector
26
Q

complications of HD

A 
thrombosis
vascular access issues
vascular disease
infection
BP shifts and hypotension
QOL
mortality
27
Q

mortality on HD

A

48% 4 yr survival

24% if older than 65 years

28
Q

fistula options

A

radiocephalic
brachiocephalic
brachiobasilic
synthetic grafts

29
Q

how does fistula work

A

to dialysi machine more distal but proximal to av graft site
from dialysis machine needle more proximal
blood coming from atery into vein

30
Q

principle of PD treatment

A 
dialysate put into peritoneal cavity
dwell time
then drained out
performed several hours
manually or with cycler

2l bags of dextrose
osmotic gradient across peritoneum
need to get wast products out of peritoneum before dextrose absorbed

Dialysate has a sugar in it that pulls fluid and waste from your blood into the dialysate. PD uses your peritoneum as a filter. The dialysate holds on to the waste and fluid and removes them from your body when you do an exchange

31
Q

malignancy clear time before transplant

A

Patients with a history of cancer
Traditionally disease free for >2 and preferably >5 years
Minimise risk of recurrence
Accelerated neoplastic growth post transplantation with immunosupppression in some cancers
Customised approach based on prognosis from Oncologist/Specialist
Malignancy death vs Dialysis death

32
Q

which cancers wait 5 years 3

A

breast
colon
malignant melanoma

33
Q

UTIs in transplant management

A

Optimise other medical issues (e.g. DM) – MDT approach, Adjust immunosuppression, ‘simple measures’ [fluid intake, pro-biotics, topical oestrogen, d-mannose] Antibiotics [low dose px, self start Rx, Methanamine Hippurate (minimal data)], Medical and surgical treatment of bladder dysfunction [BOO Rx, anti-ch/botox for poor complicance/high pressures, ISC (although avoid ‘plastic’ in Tx if poss)], native nephrectomy, anti-reflux transplant ureter options.

34
Q

CI to receive transplant 6

A

Uncontrolled malignant disease
Uncontrolled infectious disease
Any condition with a life expectancy less than 5 years* (generally half life of graft)
Active substance abuse
* quality of life (free of dialysis), return to employment, improved exercise, sexual function including pregnancy, quality of life for family, cost- particularly live donation
Reversible renal failure
Not surgically fit for the procedure

35
Q 
complications transplant
urological 3
vascular 4
wound
GI
A

urological MUC 4-8%
ureteric obstruction
urinoma urine leak
stent migration

vascular
renal artery stenosis
infarction
AV fstula
pseudoaneurysm
renal vein thrombosis
36
Q

other complications transplant

A 
persistent secondary hyper parathydoisism
increased risk stones
malignancy - skin, kaposi, lymphoma
rejection
post transplant lymphoproliferative disease
infection - pneuonia, CMV, UTI
long term immunosuppresion side effects
HTN
Diabetes
37
Q

tissue typing pre transplant 3

A

abo
HLA
cytotoxic crossmatch

38
Q

HLA class I and II

A

part of human MHC
present antigen to T cells
MHC class I CD8 T cells - HLA A, HLA B on all nucleated cells
MHC class II CD4 t cells
HLA DR, HLA DQ, HLA DP on b lymphocytes, activated t cells, monocytes, macrophages, dendritic cells

degree mismatch recorded for A, B and DR eg 0:0:1
greater mismatch, lower graft survival

39
Q

what is lymphocytotic cross match

A

Detect recipient circulating cytotoxic antibodies against HLA antigens on donor T cells

40
Q

complications renal failure

A 
fluid overload
hyperkaelamia
acidosis
cardiovascular disease
anaemia
pericarditis
renal osteodystrophy
htn
41
Q

diasylate solution

contents 8

A 
water
sodium
pottasium
calcium
magnesium
chloride
bicarbonate and glucose
PH 7.1 to 7.3
42
Q

complications fistula

A 
brachial fistulae higher rate of steal due to higher flow rates
thrombosis
stneosis
ischaemia of digits
infection
aneurysm
SVC obstruction
extravasation to limbs

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