End stage renal disease, Dialysis, and Transplant

Question 1

Stage V chronic renal disease is also known as…

Answer 1

…end stage renal disease

Question 2

Uremia definition

Answer 2

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)

Question 3

2 leading pathologies that cause end stage renal disease

Answer 3

Diabetes

Hypertension

Question 4

Stage V chronic renal disease has a GFR of below…

Answer 4

15ml/min

Question 5

End stage renal disease prognosis without treatment, with dialysis, and with transplant

Answer 5

• Mortality rate of 25% a year
• 10 years with dialysis
• up to 21 years after transplant close to normal life expectancy

Question 6

What causes death in end stage renal disease

Answer 6

Cardiac arrhythmia due to hyperkalemia

Question 7

Symptoms of end stage renal disease (4)

Answer 7

• decreased urine output
• generalized pruritus
• pitting edema
• skin pigmentation

Question 8

3 evaluations almost universal in patients with end stage renal disease

Answer 8

• elevated BUN
• elevated creatinine
• normocytic normochromatic anemia

Question 9

Treatment for anemia of end stage renal disease

Answer 9

• Erythropoietin replacement

- iron replacement as necessary

Question 10

Acute vs chronic Hemodialysis

Answer 10

Can be acute in the case of acute kidney injury for a short period of time or chronic therapy

Question 11

Benefits of renal transplant

Answer 11

Liberated from fluid restrictions, free to travel and work, can achieve correction of metabolic abnormalities and anemia with restoration of normal renal function

Question 12

Absolute contraindicatioin to hemodialysis

Answer 12

Hyperkalemia refractory to conservative measures such as diuretics or dietary restriction

Question 13

Clearance and ultrafiltration in hemodialysis

Answer 13

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

Question 14

Dialysate definition

Answer 14

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.

Question 15

Hemodialysis can treat the ___ function of the kidney but not the ___ function

Answer 15

filtering, endocrine

Question 16

Dialysis washout syndrome

Answer 16

Hypotension, cramps, nausea, etc from rapid loss of plasma solute conc during filtration from hemodialysis

Question 17

2 compartments of a dialysis machine and what separates them?

Answer 17

• Blood compartment
• dialysate compartment
• Hemodialysis filte

Question 18

Heparin’s role in hemodialysis

Answer 18

A heparin pump is required to keep the blood moving so patients on hemodialysis are consistently exposed to blood thinners

Question 19

AV fistula definition

Answer 19

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

Question 20

AV graft definition

Answer 20

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

Question 21

Tunnel catheter/permacath definition

Answer 21

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

Question 22

Home hemodialysis definition

Answer 22

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

Question 23

Renal failure is covered under….

Answer 23

…medicare

Question 24

Peritoneal dialysis

Answer 24

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

Question 25

Benefits of peritoneal dialysis (5)

Answer 25

• 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

Question 26

Complications of peritoneal dialysis

Answer 26

-Infection in peritoneal cavity or at site of catheter

Question 27

Peritoneal dialysis dialysate solution contains…

Answer 27

…electrolytes in physiologic concentrations and varying amounts of glucose to promote osmotic pressure

Question 28

Contraindications for peritoneal dialysis

Answer 28

• large body
• elderly
• severe lung disease
• abdominal surgery

Question 29

Peritoneal dialysis allows for preservation of….

Answer 29

…vasculature in case of needing to shift to hemodialysis in future

Question 30

In the case of congestive heart failure what type of dialysis should a patient undergo?

Answer 30

Peritoneal because it prevents fluid buildup between sessions

Question 31

In case of coagulopathy what type of dialysis should a patient undergo?

Answer 31

Peritoneal because it doesn’t involve anticoagulants

Question 32

Peritoneal dialysis sees decreased function after…

Answer 32

…10 years

Question 33

Prior to beginning dialysis a patient must follow a ____ diet that is ___ protein, potassium sodium and fluids

Answer 33

renal, low

Question 34

During dialysis a patient must follow a ___ diet involving ___ protein and ___ potassium and sodium, as well as daily supplements of….

Answer 34

dialysis, high, low, B complex vitamins

Question 35

Cyclosporine, a ___ class of drug has been used extensivley to improve success rate of ____

Answer 35

immunosupprssant, renal transplant

Question 36

Average wait for a kidney transplant

Answer 36

3 years

Question 37

Extra points are given to ___ awaiting a renal transplant, etiology or severity of disease are ____

Answer 37

children, not considered

Question 38

Kidney recipient contraindications (3)

Answer 38

very few including

• active or recent malignancy
• active infection
• active substance abuse

Question 39

Kidney donation complications

Answer 39

-very few issues and almost no death, complications might include hemothorax or pneumothorax

Question 40

Kidney replacement procedure

Answer 40

• 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