Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3B week 3 - renal failure > end stage renal failure and renal replacement therapy > Flashcards

end stage renal failure and renal replacement therapy Flashcards

1
Q

2 renal replacement therapy modalities

A
  1. dialysis
  2. kidney transplantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 2 types of dialysis

A
  1. haemodialysis
  2. peritoneal dilaysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the chronic kidney disease classification (5)

A

stage 1 - kidney damage with normal or increased GFR (>90)
stage 2 - kidney damage with mildly reduced GFR (60-80)
stage 3 - moderately reduced GFR (30-59)
stage 4 - severely reduced GFR (15-29)
stage 5 - kidney failure (<15 or dialysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

should pts with eGFR >60 be considered to have CKD

A

not unless they have:
1. urinary abnormalities (proteinuria, haematuria etc.)
2. structural abnormalities
3. genetic disease
4. histologically established disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

causes of CKD (8)

A
  1. T2DM
  2. HTN
  3. glomerular disease
  4. idiopathic
  5. T1DM
  6. cystic/hereditary
  7. nephiritis
  8. tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are ppl w CKD more likely to die from

A

cardiovascular disease (2-4x higher risk) -> more likley to die form CD before they progress to renal failure
both reduced eGFR and proetinuria are independently and additively associated with adverse CV outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

examples of presentation of chronic kidney disease (6)

A

very wide range of symptoms, examples of some are:
1. fluid overload
2. uremia (retention of uric toxicns)
3. acidemia
4. anemia (CKD 4)
5. mineral bone disease
6. hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how can sodium retention and volume overload be treated in CKD

A

sodium restriction diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how can hyperkalemia be treated in CKD

A
  1. dietry restriction
  2. avoid NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how can metabolic acidosis be treated in CKD

A

NaHCO3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how can abnormal Ca/PO4 balance be treated in CKD

A
  1. phosphate binders (reduce hyperphosphantemia)
  2. calcimimetics (hypocalcaemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how can anaemia be treated in CKD

A
  1. erythropoeises stimulating agents
  2. iron replacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the aim of renal replacement therapy

A

replaces normal blood-filtering functions of the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is haemodyalisis

A

ongoing dialysis that takes place at a dialysis centre 3-5x a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

explain the process of haemodyalisis (4)

A
  1. blood is exposed to dialysate acriss semi-permiable membrane
  2. Small molecules(urea, creatinine) and electrolytes pass through pores in membrane, large molecules(albumin, Ig’s) and blood cells do not
  3. Concentration differences across the membrane allow molecules to diffuse down a gradient
  4. Waste products are removed and desirable molecules replaced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is required for haemodialysis (5)

A
  1. Dialysis membrane- biocompatible membrane with adequate surface area/permeability for solute clearance and ultrafiltration;
  2. Dialysate- fluid containing physiological electrolytes concentration of sufficient purity;
  3. Effective control and safety mechanisms- pumps for blood and dialysate flow, transmembrane pressure, temperature, detection of blood/air leaks;
  4. Vascular access
  5. Anticoagulation
17
Q

in haemodialysis, how is water driven through the membrane and how is water removal controlled

A
  1. driven through by hydrostatic forces (high pressure in blood, low in dialysis fluid) -> ultrafiltration
  2. varying the pressure gradient across the membrane controls water removal
18
Q

what is the dialyser

A

the “artifical kidney” -> different SAs available depending on the size of the pt

19
Q

what is haemodiafiltration

A

combination of diffusion and convection to enhance the clearance of middle molecules -> removal of higher molecular weight uraemic toxins, greater haemodynamic stability and reduces erythropoiesis-stimulating agents (ESAs) requirements

20
Q

2 types of haemodialysis access

A
  1. filstula - optimal form of vascular access, surgical anastomosis of artery and vein required
  2. tunnelled line - frail, elderly pts or those who cannot have fistula
21
Q

what arteries/veins are used in fistula haemodialysis access (3)

A

start distally in non-dominant arm
1. radial artery + cephalic vein
2. brachial artery + cephalic vein
3. brachial artery + basilic vein

22
Q

from which end of the fistula is blood taken from and to where is it returned

A

taken from distal end of vein, returned to proximal end

23
Q

why is a fistula preferred over a tunnelled line of dialysis access

A

tunnelled line is more prone to infection

24
Q

can haemodyalisis be done at home

A

yes - patient can perform nocturnal, daily dialysis
-> majority done in hospital as pts have to learn a lot about dialysis, they are responsible for their own care and must pass the training

25
Q

will dialysis pts still exhibit uremic symptoms

A

yes - many will still experience pruritis, fatigue and pain

26
Q

what is peritoneal dialysis

A

a type of dialysis that uses the peritoneum in a person’s abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood

27
Q

how does peritoneal dialysis work (3)

A

solutes and fluids move between the fluid-filled peritoneum via the “three pore model”
1. large pores -> allow macromolecules/proteins to be filtered (via venular/lymphatic absorption)
2. small pores - responsible for the transport of small solutes (Na+/K+/ urea/ creatnine )
3. ultra small pores - transport water alone

28
Q

what channel is responsible for the transport of water through membranes in the kidney

A

aquaporin 1

29
Q

advantages of peritoneal dialysis (7)

A
  1. preservation of residual kidney function
  2. no need for vascular access
  3. mobility (no need for dialysis centre)
  4. patient engagement in treatment
  5. home based therapary -> independance
  6. less expensive
  7. less risk of transmission of blood borne viruses
30
Q

contraindications of peritoneal dialysis (5)

A
  1. patient/carer unable to train adequately
  2. hernias (inguinal, umbilical, diaphragmatic)
  3. ileostomy/colostomy
  4. abdominal wall/intra abdominal infections
  5. previous extensive surgeries/RT (adhersions/fibrosis)
31
Q

what is the correct position of peritoneal dialysis catheter

A

in the pelvis

32
Q

what can disrupt the position of the catheter in peritoneal dialysis

A

faecle loading

33
Q

advantages of renal transplantation (3)

A
  1. improved survivial + QoL
  2. more complete correction of uermia, anaemia, mineral bone disease
  3. improved sexual function and fertility
34
Q

are native kidneys removed prior to transplantation

A

not unless there are complications e.g. recurrent infection

35
Q

where is a kidney transplant placed and what arteries is it connected to

A

placed in the RIF and connected to external/internal iliac arteries

36
Q

lifespan of a living donor kidney transplant vs deceased

A

living 12-20 yrs
deceased 8-12 years

37
Q

to whom is conservative mgx offered to

A

frail + elderly pts who would not benefit from RRT -> focus is on symptom control

3B week 3 - renal failure (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions