Jan18 M3-Renal replacement therapies Flashcards
old word for renal failure
uremia
table on CKD stage: 2 things taken into consideration
GFR + Alb/Cr ratio (mmol/g)
how incidence of CKD is changing and how prevalence of pts on dialysis/received transplant is changing
CKD increasing
but also dialysis/transplant increasing
why do they do a fistula before dialysis
to put the catheter in a vein that is going to have a high P (bc connected to artery0
2 compartments in dialysis machine
-blood
-dialysate
separated by artifical membrane
principle of peritoneal dialysis
dialysate is put in the abdominal cavity and it is used as a filtration membrane
what does the dialysis machine do to increase exchange
blood flow and dialysate flow in opposite directions
max size of stuff passing through the membrane
smaller than albumin
how invented dialysis and when
Turner
why was dialysis limited in time in early 1900s
clotting problems
who invented the idea of a shunt (was a tube at the time) between artery and vein
Scribner
issue with tube as shunt
put on and removed every time
clotting
infection
first person to perfect the AV fistula technique for dialysis
James Cimino
why no clotting problems with the AV fistula
high flow because artery connected to the vein
alternative if no suitable vessels for a fistula
central vein catheter in the jugular vein
disadvantages of jugular vein dialysis catheter
infection, clotting
how coagulation inside the dialysis machine is avoided today
filtration polymers have better properties and better anticoagulation properties
dialysis for AKI
CRRT (continuous renal replacement therapy)
peritoneal dialysis: what to do if someone is fluid overloaded
dialysate is made hypertonic
3 factors that affect diffusion
- conc gradient
- molecular weight
- membrane
how to remove urea from the blood during dialysis
you put no urea in the dialysate
in high P/hypervolemic patients, how do you ultrafiltrate + def of that
ultrafiltration = moving water across the membrane
roller pump creates hydrostatic P to push plasma out
3 factors that determine if a molecule can be dialyzed
- size
- degree of protein binding (how much is it bound to a protein)
- solubility (water vs fat soluble)
when to use acute dialysis
- AKI with uremic symptoms, hyperK, acidosis, volume overload, pericarditis
- drug toxicity with or without renal failure
indication for chronic dialysis
uremic symptoms and GFR below 10
dialysis provides a clearance (GFR) equivalent to what (what’s the new GFR reached with dialysis)
15 ml per min
best therapy for kidney failure and why
renal transplant: lowest mortality risk
why risk of death is still higher than general pop for renal transplant patients
CV causes, malignancy, infection
meds you must always take with got renal transplant
immunosuppresion
why do we need immunosuppresion drugs
never have absolute HLA identity
4 immunosuppression drugs
- calcineurin inhibitors
- corticosteroids
- antimetabolites
- receptor blockers
how immunosuppression drugs work
prevent recognition of foreign cells by own immune system by disrupting antigen presentation from APCs to T cells
can anyone donate a kidney?
no, have to be tested for prior medical problems or transmissible disease
how to calculate new GFR after gave a kidney
half the old GFR
50% drop in GFR but it’s enough
3 organ donations that can come from a living donor
lobe of the lung, lobe of the liver, kidney
does someone who receives an organ get the same outcome if it was a living donor or a deceased donor?
no bc the organ from the deceased donor underwent some ischemia
regenerative solution for kidney bioengineering that has the most potential in the next 10 years
re-cellularized scaffolds
5 methods of kidney bioengineering being made
- renal organoids
- re-cellularized scaffolds
- stem cells
- 3D printing
- kidney chips (for drug screening)
