Dialysis/transplant/renal function Flashcards

Question

HD circuit components

Answer 1

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

Answer 2

``` thrombosis vascular access issues vascular disease infection BP shifts and hypotension QOL mortality ```

Answer 3

48% 4 yr survival | 24% if older than 65 years

Answer 4

radiocephalic brachiocephalic brachiobasilic synthetic grafts

Answer 5

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

Answer 6

``` 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

Answer 7

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

Answer 8

breast colon malignant melanoma

Answer 9

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.

Answer 10

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

Answer 11

urological MUC 4-8% ureteric obstruction urinoma urine leak stent migration ``` vascular renal artery stenosis infarction AV fstula pseudoaneurysm renal vein thrombosis ```

Answer 12

``` 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 ```

Answer 13

abo HLA cytotoxic crossmatch

Answer 14

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

Answer 15

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

Answer 16

``` fluid overload hyperkaelamia acidosis cardiovascular disease anaemia pericarditis renal osteodystrophy htn ```

Answer 17

``` water sodium pottasium calcium magnesium chloride bicarbonate and glucose PH 7.1 to 7.3 ```

Answer 18

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