ESRD: Dialysis and Transplant (2 hrs) Flashcards
While there’s no specific GFR or BUN that indicate we should start dialysis, what is a good general guideline?
When the risks of uremic complications in the patient outweigh the risks of dialysis
List the AEIOU’s of recommended dialysis initiation.
A=Acidemia
E=Electrolyte imbalance
I=Intoxication
O=Overload of fluid
U=Uremia
When does Medicaire start covering dialysis? (this is pretty much the value that dialysis tends to start around)
GFR<15 for patients with diabetes
GFR<12 for patients who don’t have diabetes
What are the 2 different modalities of dialysis? What are some of the characteristics?
1) Hemodialysis (pump the blood out and filter it with artificial dialysate fluid). More common in the US, more expensive, typically 3 times a week for 4 hours each time. Easier to travel with this (you can go to centers where you travel to)
2) Peritoneal dialysis. You have a permanent catheter that you pump dialysate into your peritoneal cavity through and then drain it. Doesn’t require treatment in a lab, harder to travel since you need dialysate everywhere you go. Cheaper and more common around the world.
What are the 3 different accesses for hemodialysis and rank them from best to worst.
1) AV fistula (best). An artificial anastamoses between artery and vein, less infection, less procedures, long lifespan. May never work, ischemic symptoms, lots of needle sticks. *Done on non dominant arm.
2) AV Graft: no long maturation, less infections than catheter. Cons: rejection can occur, stenosis, shorter lifespan.
3) Catheter: Placed in IJV. Good blood flow, immediate. Cons: high infection, high dysfunction, high mortality.
What are some medical complications of hemodialysis?
Muscle cramping
Hypotension
Headache
Chest Pain
Air embolism (rare)
Staph Aureus infection
What are some common medical complications of peritoneal dialysis?
Infection (from gram pos or neg)
Catheter malfunction (clogging, can’t drain)
Hernias! (can’t start if you have hernia)
Metabolic complications
Peritoneal scarring
At what point does the mortality risk from kidney transplant become lower than the mortality risk from dialysis
After 106 days.
For which blood group is the wait list the shortest?
AB
T or F?
Dialysis is cheaper in the long run than a kidney transplant
False
Dialysis actually costs 2x as much as kidney transplant per year.
What are some of the risks of kidney transplant?
Infection from being on immunosuppressants
Higher rates of cancer
Drug side effects
Which kidney is preferred for transplant and why?
The left is preferred because it has a longer renal vein.
It’s usually transplanted into the right side and anastamosed with the right external iliac a. and v. and the donor ureter is anastamosed to the recipient’s bladder
Rank the following from best to worst for deceased donor kidneys
SCD
DCD
ECD
1) SCD=Standard. Brain dead w/ cardiopulmonary still in tact.
2) DCD=Cardiac death. Heart stops prior to organ retrieval
3) ECD=Extended. Donor older than 60 or between 50 and 59 with history of hypertension, history of stroke, or increased creatinine. Not ideal, shorter wait list.
What happens if you get antibody rejection to a transplant organ?
Treat with plasmapheresis to take out the antibodies and then keep them on IVIG or a mab to prevent further antibody formation
What’s the difference between MHC Class 1 and MCH Class 2 genes?
MHC Class 1 present intracellular antigens to CD8 T cells (viral response). These T cells cause direct damage to the graft.
MHC Class 2 present antigents to CD4 T cells which are helper T cells (bacterial response). These tend to create antibodies that will have complement reaction with the graft.
