ESRD: Dialysis and Transplant Flashcards

1
Q

What are the goals of dialysis?

A

to remove toxins, to maintain euvolemia

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2
Q

What are the 2 major types of dialysis?

A

hemodialysis and peritoneal dialysis

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3
Q

When is dialysis necessary?

A

in severe hyperkalemia, severe volume overload, uremic pericarditis

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4
Q

At what GFR is dialysis started?

A

there is no specific GFR guideline

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5
Q

_____ is the most common dialysis modality in the US.

A

Hemodialysis

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6
Q

What is the preferred access for dialysis?

A

arteriovenous fistula (AVF)

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7
Q

How is an AVF created?

A

surgical anastomosis of an artery to a vein, usually in the arm

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8
Q

What are the benefits to AVF dialysis access?

A

low infection rate

can be used longer than all other forms

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9
Q

What are the benefits to arteriovenous grafts (AVGs) dialysis access?

A

they can be used more quickly

higher 1a success rate

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10
Q

What are the benefits to dual lumen catheter dialysis access?

A

immediate use

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11
Q

What are the drawbacks to AVF dialysis access?

A

they take time to mature (months) and sometimes don’t work

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12
Q

What are the drawbacks to arteriovenous grafts (AVGs) dialysis access?

A

they fail quickly

higher infection risk

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13
Q

What are the drawbacks to dual lumen catheter dialysis access?

A

much higher infection rate

high rate of dysfunction

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14
Q

The most common complication of hemodialysis is _____.

A

bloodstream infection

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15
Q

What are the most common bugs causing infection in hemodialysis?

A

gram + (Staph aureus and coagulase-negative staph)

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16
Q

Why is peritoneal dialysis used so frequently outside the US?

A

it’s cheap and gives the pt autonomy and freedom

17
Q

What are the drawbacks of peritoneal dialysis?

A

they can cause hernias, infectious peritonitis, catheter problems

18
Q

Patients starting dialysis have a mortality rate greater than ___% for their first year and ____% after 5 years.

19
Q

Dialysis pts most commonly die from _____.

A

CV disease and infections

20
Q

____ is currently the tx of choice for end-stage renal disease.

A

Kidney transplant

21
Q

The median waiting time for a kidney transplant is ____.

A

2 years (AB) to 5.5 years (B or O)

22
Q

Which kidney is preferred for donation? Why?

A

the left b/c it has a longer renal vein

23
Q

The MHC is a group of genes located on the ___ arm of chromosome ____.

24
Q

MHC Class ___ is present on all nucleated cells.

25
MHC Class I antigens present peptides to ____ cells.
CD8+ cytotoxic T cells
26
MHC Class ____ antigens present peptides to CD8+ cytotoxic T cells.
I
27
MHC Class ___ antigens present extracellular proteins to CD4+ helper T cells.
II
28
MHC Class II antigens present extracellular proteins to _____ cells.
CD4+ helper T
29
What cells carry MHC class II?
dendritic cells, B cells, macs
30
How many HLA matches are taken into account in kidney transplantation?
6
31
The degree of HLA matching affects ___ in kidney transplantation.
long term graft survival
32
What drugs are given to kidney transplant patients to prevent graft rejection?
a calcineurin inhibitor a proliferation signal inhibitor prednisone
33
Name 2 calcineurin inhibitors.
cyclosporine and tacrolimus
34
Name 2 classes of proliferation inhibitors.
mycophenolate mofetil, mTOR inhibitors
35
How does mycophenoate mofetil work?
it inhibits purine synthesis