End stage renal disease, Dialysis, and Transplant Flashcards
craig bae
Stage V chronic renal disease is also known as…
…end stage renal disease
Uremia definition
Raised level of urea in the blood stream that can eventually reach toxic levels in the blood causing different effects to different organs (pericarditis, encephalopathy, pleural effusion)
2 leading pathologies that cause end stage renal disease
Diabetes
Hypertension
Stage V chronic renal disease has a GFR of below…
15ml/min
End stage renal disease prognosis without treatment, with dialysis, and with transplant
- Mortality rate of 25% a year
- 10 years with dialysis
- up to 21 years after transplant close to normal life expectancy
What causes death in end stage renal disease
Cardiac arrhythmia due to hyperkalemia
Symptoms of end stage renal disease (4)
- decreased urine output
- generalized pruritus
- pitting edema
- skin pigmentation
3 evaluations almost universal in patients with end stage renal disease
- elevated BUN
- elevated creatinine
- normocytic normochromatic anemia
Treatment for anemia of end stage renal disease
- Erythropoietin replacement
- iron replacement as necessary
Acute vs chronic Hemodialysis
Can be acute in the case of acute kidney injury for a short period of time or chronic therapy
Benefits of renal transplant
Liberated from fluid restrictions, free to travel and work, can achieve correction of metabolic abnormalities and anemia with restoration of normal renal function
Absolute contraindicatioin to hemodialysis
Hyperkalemia refractory to conservative measures such as diuretics or dietary restriction
Clearance and ultrafiltration in hemodialysis
Clearance is elimination of solute from blood via diffusion (moving from high conc. to low)
Ultrafiltration is removal of excess liquid while retaining particles useful to the body
Dialysate definition
Fluid used to remove or deliver compounds that a failing kidney cannot secret or retain in proper concentration, contains balanced solution of sodium, potassium, calcium, etc.
Hemodialysis can treat the ___ function of the kidney but not the ___ function
filtering, endocrine
Dialysis washout syndrome
Hypotension, cramps, nausea, etc from rapid loss of plasma solute conc during filtration from hemodialysis
2 compartments of a dialysis machine and what separates them?
- Blood compartment
- dialysate compartment
- Hemodialysis filte
Heparin’s role in hemodialysis
A heparin pump is required to keep the blood moving so patients on hemodialysis are consistently exposed to blood thinners
AV fistula definition
The gold standard or best means of vascular access for hemodialysis, often formed from sowing the cephalic vein and radial artery to allow for high blood flow rate in the vein while maintaining easy puncture access
AV graft definition
An alternative means of hemodialysis access chosen for those with poor vasculature, involves insertion of a graft tube between arterial and venous circulation, not preferred due to increased risk of infection and thrombosis compared to AV fistula
Tunnel catheter/permacath definition
A tunnel catheter thru the internal jugular to the vena cava used for chronic hemodialysis sessions but not preferred due to high rate of infection and clotting
Home hemodialysis definition
A growing popular alternative to dialysis centers where a trained caregiver can give dialysis and gain access to av fistula or graft and run machine
Renal failure is covered under….
…medicare
Peritoneal dialysis
A form of dialysis that uses the peritoneal membrane as a filter following injection of 2-3 L of dialysate to be filled and drained periodically opposed to the machine to deliver continuous dialysis
Benefits of peritoneal dialysis (5)
- no need for vascular access
- no anticoagulants involved
- slow continuous process avoiding hemodynamic shifts
- greater independence as patients can self amdinister
- less need to restrict salt, protein and fluid in diet
Complications of peritoneal dialysis
-Infection in peritoneal cavity or at site of catheter
Peritoneal dialysis dialysate solution contains…
…electrolytes in physiologic concentrations and varying amounts of glucose to promote osmotic pressure
Contraindications for peritoneal dialysis
- large body
- elderly
- severe lung disease
- abdominal surgery
Peritoneal dialysis allows for preservation of….
…vasculature in case of needing to shift to hemodialysis in future
In the case of congestive heart failure what type of dialysis should a patient undergo?
Peritoneal because it prevents fluid buildup between sessions
In case of coagulopathy what type of dialysis should a patient undergo?
Peritoneal because it doesn’t involve anticoagulants
Peritoneal dialysis sees decreased function after…
…10 years
Prior to beginning dialysis a patient must follow a ____ diet that is ___ protein, potassium sodium and fluids
renal, low
During dialysis a patient must follow a ___ diet involving ___ protein and ___ potassium and sodium, as well as daily supplements of….
dialysis, high, low, B complex vitamins
Cyclosporine, a ___ class of drug has been used extensivley to improve success rate of ____
immunosupprssant, renal transplant
Average wait for a kidney transplant
3 years
Extra points are given to ___ awaiting a renal transplant, etiology or severity of disease are ____
children, not considered
Kidney recipient contraindications (3)
very few including
- active or recent malignancy
- active infection
- active substance abuse
Kidney donation complications
-very few issues and almost no death, complications might include hemothorax or pneumothorax
Kidney replacement procedure
- recipients kidneys are not removed (to preserve any endocrine or filtration function left)
- new kidney placed in iliac fossa
- renal artery/vein of donated kidney is connected to external iliac artery/vein of recipient
- donated ureter attached to recipient bladder
