ESRD: Dialysis and Transplant Flashcards
What are the goals of dialysis?
to remove toxins, to maintain euvolemia
What are the 2 major types of dialysis?
hemodialysis and peritoneal dialysis
When is dialysis necessary?
in severe hyperkalemia, severe volume overload, uremic pericarditis
At what GFR is dialysis started?
there is no specific GFR guideline
_____ is the most common dialysis modality in the US.
Hemodialysis
What is the preferred access for dialysis?
arteriovenous fistula (AVF)
How is an AVF created?
surgical anastomosis of an artery to a vein, usually in the arm
What are the benefits to AVF dialysis access?
low infection rate
can be used longer than all other forms
What are the benefits to arteriovenous grafts (AVGs) dialysis access?
they can be used more quickly
higher 1a success rate
What are the benefits to dual lumen catheter dialysis access?
immediate use
What are the drawbacks to AVF dialysis access?
they take time to mature (months) and sometimes don’t work
What are the drawbacks to arteriovenous grafts (AVGs) dialysis access?
they fail quickly
higher infection risk
What are the drawbacks to dual lumen catheter dialysis access?
much higher infection rate
high rate of dysfunction
The most common complication of hemodialysis is _____.
bloodstream infection
What are the most common bugs causing infection in hemodialysis?
gram + (Staph aureus and coagulase-negative staph)
Why is peritoneal dialysis used so frequently outside the US?
it’s cheap and gives the pt autonomy and freedom
What are the drawbacks of peritoneal dialysis?
they can cause hernias, infectious peritonitis, catheter problems
Patients starting dialysis have a mortality rate greater than ___% for their first year and ____% after 5 years.
20; 50
Dialysis pts most commonly die from _____.
CV disease and infections
____ is currently the tx of choice for end-stage renal disease.
Kidney transplant
The median waiting time for a kidney transplant is ____.
2 years (AB) to 5.5 years (B or O)
Which kidney is preferred for donation? Why?
the left b/c it has a longer renal vein
The MHC is a group of genes located on the ___ arm of chromosome ____.
short; 6
MHC Class ___ is present on all nucleated cells.
I
MHC Class I antigens present peptides to ____ cells.
CD8+ cytotoxic T cells
MHC Class ____ antigens present peptides to CD8+ cytotoxic T cells.
I
MHC Class ___ antigens present extracellular proteins to CD4+ helper T cells.
II
MHC Class II antigens present extracellular proteins to _____ cells.
CD4+ helper T
What cells carry MHC class II?
dendritic cells, B cells, macs
How many HLA matches are taken into account in kidney transplantation?
6
The degree of HLA matching affects ___ in kidney transplantation.
long term graft survival
What drugs are given to kidney transplant patients to prevent graft rejection?
a calcineurin inhibitor
a proliferation signal inhibitor
prednisone
Name 2 calcineurin inhibitors.
cyclosporine and tacrolimus
Name 2 classes of proliferation inhibitors.
mycophenolate mofetil, mTOR inhibitors
How does mycophenoate mofetil work?
it inhibits purine synthesis
