Haemolysis Clinical Demonstration

Question 1

what is the function of the kidneys

Answer 1

Removal/regulation

• Ur/Cr
• Electrolytes

Fluid balance
- Salt/Water

Hormone production
Bone metabolism
Red blood cell production

MAINTAIN HOMEOSTATSIS

Question 2

What happens when the kidneys stop working

Answer 2

SWEAT 
Salt 
Water
Electrolytes
Acidosis
Toxins 

AEIOU (Vowels)
Acidosis
Electrolytes – key electrolyte is potassium - can cause hyperkalemia – fatal
(Intoxications)
Overload
Uraemia – suffering from the toxic effects of urea

Question 3

name 3 types of abnormal kidney function

Answer 3

pre-renal
renal
post renal

Question 4

describe the 3 types of abnormal kidney function

Answer 4

pre-renal - before the kidneys
renal -problems with the kidney
post renal - this is an inability to drain the kidney - for example this could be due to kidney stones or large prostates

Question 5

name some types of acute kidney injury

Answer 5

STOP
Sepsis & Hypoperfusion
Toxicity
Obstruction
Parenchymal Disease

Question 6

name some chronic kidney diseases and which order they are most caused

Answer 6

1, glomerulonephritis 
2, diabetes
3, other
4, unknown aetiology 
5, polynephritis
6, polycystic kidney disease

Question 7

how do we assess renal function

Answer 7

serum urea and creatine

• Small molecules
• Filtered by glomerulus – measure of GFR

Question 8

what does the level of creatine always depends on

Answer 8

Muscle mass
Body size
Sex and race

Question 9

if the glomerular filtrate rate is high ….

Answer 9

then the creatine concentration is low in the plasma

Question 10

if the glomerular filtration rate is low then…

Answer 10

the creatine concentration is high in the plasma as the creatinine is not filtered out

Question 11

name the CKD levels

Answer 11

Stage 1 with normal or high GFR (GFR > 90 mL/min)

Stage 2 Mild CKD (GFR = 60-89 mL/min)

Stage 3A Moderate CKD (GFR = 45-59 mL/min)

Stage 3B Moderate CKD (GFR = 30-44 mL/min)

Stage 4 Severe CKD (GFR = 15-29 mL/min)

Stage 5 End Stage CKD (GFR <15 mL/min)

Question 12

what is the level of CKD 3 and what happens to patients in CKD3

Answer 12

CKD 3 eGFR 30-59

70-80% Hypertension
12-25% Anaemic
9-18% Acidotic
9% High Pi
3-9% Malnourished 
23-44% High PTH

Question 13

what is the level of CKD 4 and what happens to patients in CKD 4

Answer 13

CKD 4 eGFR 15-29

85% Hypertension
50% Anaemic
30% Acidotic
23% High Pi
3-9% Malnourished 
75% High PTH

Question 14

when do renal replacement therapies start

Answer 14

Start when symptomatic: GFR 5-10ml/min

Question 15

what are the 4 options for renal replacement therapy

Answer 15

Conservative and expectant £?

Haemodialysis £24,000/pt/yr

Periotneal Dialysis £20,000/pt/yr

Transplantation £14,000/pt
£5,000/pt

Question 16

what are the two ways that exchange of solutes and fluid across the membrane occur in dialysis

Answer 16

diffusion - along concentration gradient

convection- solute movement with fluid - uses hydrostatic pressure and osmotic load to move molecules along the membrane

Question 17

what type of membrane does dialysis occur across in Haemodialysis and in peritoneal dialysis

Answer 17

• Haemodialysis = artificial membrane

- peritoneal dialysis - peritoneal membrane

Question 18

what is peritoneal dialysis

Answer 18

• this is a type of dialysis where catheter is placed into the abdomen and the peritoneal membrane forms a semipermeable membrane
• need to put fluid into the peritoneal so exchange can take place
• put things that you want to go into the blood in the fluid too

Question 19

what are the advantages of peritoneal dialysis and what are the disadvantages of peritoneal dialysis

Answer 19

Advantages

• continuous
• independence
• Less CardioVascular demanding
• Can do it at home

Disadvantages

• patient competence
• Membrane failure, abnormal glycosylation
• Can do it at home – cant do it at home cant do it
• Over time the perotneal gets worn out
• If you don’t make any urine then you may not get enough clearance from periotenal dialysis

Question 20

what are the complications of peritoneal dialysis

Answer 20

Exit site infection
Tunnel infection
PD peritonitis

Question 21

what are the complications of Haemodialysis

Answer 21

• Infection
• Exit site
• Tunnel
• Septicaemia - Most frequently Gram positive (Staph)

Central Venous Stenosis
- Especially left sided lines

Question 22

what are the problems with Haemodialysis accessing

Answer 22

Thrombosis
Infection
Leak
Vascular anatomy changes