Haemolysis Clinical Demonstration Flashcards
what is the function of the kidneys
Removal/regulation
- Ur/Cr
- Electrolytes
Fluid balance
- Salt/Water
Hormone production
Bone metabolism
Red blood cell production
MAINTAIN HOMEOSTATSIS
What happens when the kidneys stop working
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
name 3 types of abnormal kidney function
pre-renal
renal
post renal
describe the 3 types of abnormal kidney function
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
name some types of acute kidney injury
STOP Sepsis & Hypoperfusion Toxicity Obstruction Parenchymal Disease
name some chronic kidney diseases and which order they are most caused
1, glomerulonephritis 2, diabetes 3, other 4, unknown aetiology 5, polynephritis 6, polycystic kidney disease
how do we assess renal function
serum urea and creatine
- Small molecules
- Filtered by glomerulus – measure of GFR
what does the level of creatine always depends on
Muscle mass
Body size
Sex and race
if the glomerular filtrate rate is high ….
then the creatine concentration is low in the plasma
if the glomerular filtration rate is low then…
the creatine concentration is high in the plasma as the creatinine is not filtered out
name the CKD levels
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)
what is the level of CKD 3 and what happens to patients in CKD3
CKD 3 eGFR 30-59
70-80% Hypertension 12-25% Anaemic 9-18% Acidotic 9% High Pi 3-9% Malnourished 23-44% High PTH
what is the level of CKD 4 and what happens to patients in CKD 4
CKD 4 eGFR 15-29
85% Hypertension 50% Anaemic 30% Acidotic 23% High Pi 3-9% Malnourished 75% High PTH
when do renal replacement therapies start
Start when symptomatic: GFR 5-10ml/min
what are the 4 options for renal replacement therapy
Conservative and expectant £?
Haemodialysis £24,000/pt/yr
Periotneal Dialysis £20,000/pt/yr
Transplantation £14,000/pt
£5,000/pt
what are the two ways that exchange of solutes and fluid across the membrane occur in dialysis
diffusion - along concentration gradient
convection- solute movement with fluid - uses hydrostatic pressure and osmotic load to move molecules along the membrane
what type of membrane does dialysis occur across in Haemodialysis and in peritoneal dialysis
- Haemodialysis = artificial membrane
- peritoneal dialysis - peritoneal membrane
what is peritoneal dialysis
- 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
what are the advantages of peritoneal dialysis and what are the disadvantages of peritoneal dialysis
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
what are the complications of peritoneal dialysis
Exit site infection
Tunnel infection
PD peritonitis
what are the complications of Haemodialysis
- Infection
- Exit site
- Tunnel
- Septicaemia - Most frequently Gram positive (Staph)
Central Venous Stenosis
- Especially left sided lines
what are the problems with Haemodialysis accessing
Thrombosis
Infection
Leak
Vascular anatomy changes
