Jan18 M3-Renal replacement therapies

Question 1

old word for renal failure

Answer 1

uremia

Question 2

table on CKD stage: 2 things taken into consideration

Answer 2

GFR + Alb/Cr ratio (mmol/g)

Question 3

how incidence of CKD is changing and how prevalence of pts on dialysis/received transplant is changing

Answer 3

CKD increasing

but also dialysis/transplant increasing

Question 4

why do they do a fistula before dialysis

Answer 4

to put the catheter in a vein that is going to have a high P (bc connected to artery0

Question 5

2 compartments in dialysis machine

Answer 5

-blood
-dialysate
separated by artifical membrane

Question 6

principle of peritoneal dialysis

Answer 6

dialysate is put in the abdominal cavity and it is used as a filtration membrane

Question 7

what does the dialysis machine do to increase exchange

Answer 7

blood flow and dialysate flow in opposite directions

Question 8

max size of stuff passing through the membrane

Answer 8

smaller than albumin

Question 9

how invented dialysis and when

Answer 9

Turner

Question 10

why was dialysis limited in time in early 1900s

Answer 10

clotting problems

Question 11

who invented the idea of a shunt (was a tube at the time) between artery and vein

Answer 11

Scribner

Question 12

issue with tube as shunt

Answer 12

put on and removed every time
clotting
infection

Question 13

first person to perfect the AV fistula technique for dialysis

Answer 13

James Cimino

Question 14

why no clotting problems with the AV fistula

Answer 14

high flow because artery connected to the vein

Question 15

alternative if no suitable vessels for a fistula

Answer 15

central vein catheter in the jugular vein

Question 16

disadvantages of jugular vein dialysis catheter

Answer 16

infection, clotting

Question 17

how coagulation inside the dialysis machine is avoided today

Answer 17

filtration polymers have better properties and better anticoagulation properties

Question 18

dialysis for AKI

Answer 18

CRRT (continuous renal replacement therapy)

Question 19

peritoneal dialysis: what to do if someone is fluid overloaded

Answer 19

dialysate is made hypertonic

Question 20

3 factors that affect diffusion

Answer 20

• conc gradient
• molecular weight
• membrane

Question 21

how to remove urea from the blood during dialysis

Answer 21

you put no urea in the dialysate

Question 22

in high P/hypervolemic patients, how do you ultrafiltrate + def of that

Answer 22

ultrafiltration = moving water across the membrane

roller pump creates hydrostatic P to push plasma out

Question 23

3 factors that determine if a molecule can be dialyzed

Answer 23

• size
• degree of protein binding (how much is it bound to a protein)
• solubility (water vs fat soluble)

Question 24

when to use acute dialysis

Answer 24

• AKI with uremic symptoms, hyperK, acidosis, volume overload, pericarditis
• drug toxicity with or without renal failure

Question 25

indication for chronic dialysis

Answer 25

uremic symptoms and GFR below 10

Question 26

dialysis provides a clearance (GFR) equivalent to what (what’s the new GFR reached with dialysis)

Answer 26

15 ml per min

Question 27

best therapy for kidney failure and why

Answer 27

renal transplant: lowest mortality risk

Question 28

why risk of death is still higher than general pop for renal transplant patients

Answer 28

CV causes, malignancy, infection

Question 29

meds you must always take with got renal transplant

Answer 29

immunosuppresion

Question 30

why do we need immunosuppresion drugs

Answer 30

never have absolute HLA identity

Question 31

4 immunosuppression drugs

Answer 31

• calcineurin inhibitors
• corticosteroids
• antimetabolites
• receptor blockers

Question 32

how immunosuppression drugs work

Answer 32

prevent recognition of foreign cells by own immune system by disrupting antigen presentation from APCs to T cells

Question 33

can anyone donate a kidney?

Answer 33

no, have to be tested for prior medical problems or transmissible disease

Question 34

how to calculate new GFR after gave a kidney

Answer 34

half the old GFR

50% drop in GFR but it’s enough

Question 35

3 organ donations that can come from a living donor

Answer 35

lobe of the lung, lobe of the liver, kidney

Question 36

does someone who receives an organ get the same outcome if it was a living donor or a deceased donor?

Answer 36

no bc the organ from the deceased donor underwent some ischemia

Question 37

regenerative solution for kidney bioengineering that has the most potential in the next 10 years

Answer 37

re-cellularized scaffolds

Question 38

5 methods of kidney bioengineering being made

Answer 38

• renal organoids
• re-cellularized scaffolds
• stem cells
• 3D printing
• kidney chips (for drug screening)