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AY Renal > Dialysis & transplantation > Flashcards

Dialysis & transplantation Flashcards

1
Q

What is dialysis?

A

Semipermeable membrane based on diffusion removes toxins from the blood

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2
Q

During dialysis which chemicals are being removed?

A

K+
Urea
Na

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3
Q

During dialysis what is added to the blood?

A

Bicarbonate

Glucose

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4
Q

What is the minimum treatment times for dialysis?

A

4 hours

3 times per week

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5
Q

What restrictions does dialysis put on patients?

A

Fluid (1L per day)
Low salt
Low potassium
Low phosphate

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6
Q

Pros of areteriovenous fistula

A

Good blood flow

Unlikely to cause infection

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7
Q

Cons of arteriovenous fistula

A

Requires surgery
6 weeks to mature
Can limit blood flow to distal arm
Can block

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8
Q

Pros of tunneled venous catheter

A

Easy to insert

Can be used immediately

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9
Q

Cons of tunneled venous catheter

A

High risk of infection

Can cause damage to veins making placing replacements difficult

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10
Q

Complications of tunneled venous catheter infection

A

Endocarditis
Discitis
Death

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11
Q

What is the most commonly used antibiotic for tunneled venous catheter

A

Vancomycin

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12
Q

Complications of dialysis

A

Fluid overload
Blood leaks
Loss of vascular access
Hypokalaemia & cardiac arrest

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13
Q

How does peritoneal dialysis work?

A

Solute removal by diffusion of solutes across the peritoneal membrane
Water removal by osmosis driven by high glucose concentration in dialysafe fluid

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14
Q

How many changes a day are needed for CAPD?

A

4 bag exchanges per day

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15
Q

Complications of PD

A

Infection
Membrane Failure
Hernia’s

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16
Q

Investigation for PD infection

A

Culture PD fluid

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17
Q

Treatment of membrane failure in peritoneal dialysis

A

Switch to haemodialysis (inabiklity to remove enough water so become fluid overload)

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18
Q

Why are patients on PD more prone to hernias?

A

Increased intraabdominal pressure

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19
Q

What are the bone metabolic complications of ESKD?

A

Phosphate retention
Low hydroxylated Vit D
Hypocalcaemia
Raised PTH

20
Q

Metabolic complications in ESKD

A

Bone mineral metabolism
Anaemia
Sodium & water retention
Accelerated CV disease

21
Q

Biochemical indications to start dialysis

A

Resistant hyperkalaemia
GFR 45
Unresponsive acidosis

22
Q

What are HLAS?

A

Cell surface proteins expressed on cells

23
Q

Why is HLA important?

A

Rejection

24
Q

What causes hyperacute rejection?

A

Due to +ve X match

25
Q

Treatment of hyperacute rejection

A

Remove kidney (unsalvagable)

26
Q

What mediates acute rejection?

A

T cells or B cells

27
Q

Management of acute rejection

A

Increased immunosupression

28
Q

Examples of calcineurin inhibitors

A

Cyclosporin

Tacrolimus

29
Q

Mechanism of action of calcineurin inhibitors

A

Inhibit activation of T helper cells by reducing NK clls activation and reduce cytotoxic T cell activation

30
Q

Side effects of calcineurin inhibitors

A

Renal dysfunction
Hypertension
Diabetes
Tremors

31
Q

What are azathioprine & mycophenolate?

A

Antimetabolites by blocking purine synthesis leads to suppression of prolieration of lymphocytes and B cells

32
Q

Side effects of azathioprine & mycophenylate

A

Leucopaenia
Anaemia
GI side effects

33
Q

Which drug does azathioprine interact with badly?

A

Aloopurinol

34
Q

Side effects of steroids

A

Osteoporosis
Weight gain
Infection
Diabetes

35
Q

What factors make a patient suitable for transplantation?

A

> 5 year life expectancy
within 6 months of HD
Tissue typing

36
Q

What is assessed in a patient before transplant?

A 
CVS risk 
Virology 
CXR
Bladder assessment 
Co-morbidities
37
Q

Absolute contraindcationf ro renal transplant

A 
Malignancy 
Untreated TB 
Severe IHD 
Severe airways disease 
Active vasculitis 
Severe PVD
38
Q

Surgical complications of transplant

A 
Bleeding 
Aterial stenosis/thrombosis 
Venous stenosis/thrombosis 
Ureteric stricture and hydronephrosis 
Wound Infection
39
Q

Signs of immediate graft function

A

Urine output good

Falling creatinine & urea

40
Q

Signs of delayed graft function

A

Post-op acute tubular necrosis

41
Q

Management of delayed graft function

A

Haemodialysis for 10-30 days till transplant works

42
Q

What happens if a transplant fails?

A

Patient back on dialysis

Can get another transplant

43
Q

Within what time frame is a rejection considered acute?

A

6 months

44
Q

What is the most common cause of viral infection in solid organ transplants?

A

Cytomegalovirus

45
Q

Treatment of cytomegalovirus

A

Ganciclovir

AY Renal (15 decks)

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