L 64 - Kidney Replacement (dialysis vs transplant)

Question 1

Dialysis is the treatment for _______syndrome; symptoms of which include_______

signs of uremic syndrome include________

Answer 1

Uremic syndrome

symptoms: 
N/V/ anorexia
fatigue, weakness
Coldness
personality changes, confused 

signs:
Shallow skin;
Pericardial friction rub
Tremor; asterixis

Question 2

2 goals of dialysis

how is this achieved

Answer 2

Removal of solutes; Removal of Fluid

solutes: removed across semipermeable membrane, concentration gradient

Fluid: Ultrafiltration – apply pressure gradient

Question 3

Dialysis requires large volume access. what are three ways to achieve this?

Answer 3

Dialysis AV Fistula: (vein is surgically connected to adjacent artery; vein subjected to arterial pressure and expands; can now insert large gauge needles)

Grafts and Indwelling caths – least desirable

Question 4

does dialysis work as well as kidneys?

how factors can be altered to improved dialysis otucomes

Answer 4

no –only clears 1/5 the urea

Outcomes affected by:
blood flow rate
the membrane of the dialyzer
Time spent on the machine

Question 5

acute complications of dialysis

chronic complications (chronic comorbidities of CKD patients)

Answer 5

Acute: anaphyalxis, disequilibrium syndrome, hypotension, N/V/ muscle cramps

Chronic – due to CKD co morbidiites :

CVD – major cause of death
Anemia
Vit D, calcium, phospohate homeostaiss

Question 6

Peritoneal dialysis- –

what is your functioning semipemrable membrane?

How is an osmotic gradient generted in peritoneal diaylsis

Answer 6

Peritoneum Membrane acts as the Semi Permeable Membrane

High levels of glucose in the dialysate

Question 7

what are the three forms of kidney transplant rejection?

what is each more mediated by?

what is the primary cause of graft loss

Answer 7

Hyperacute – anti donor antibodies

Acute - T Lymphocytes

Chronic – Antibody mediated injury; most common loss of kidney function

Question 8

How is hyperacute rejection avoided?

pathological findings
histo and gross

Answer 8

Cross matching: detection of anti-donor antibodies

Gross Path: Patchy necrosis which you can observed intra-operatively

Histo Path: Microthrombi in the new kidney

Question 9

Acute rejection

• Symptoms
• Pathology –

Treatment

Answer 9

Fever, enlarged kidney, increased weight, decrease UOP, Malaise; may be asymptomatic

Tubulitis – Antibodies collect in the peritubular capillaries

Treatment: Immunosuppresion

Question 10

pathology of chronic rejection

treatment

Answer 10

Vascular Sclerosis; an Ischemic injury to the kidney
Transplant arteritis

No good treatment

Question 11

two classic viruses to watch out for immunosuppressed transplant patients

Answer 11

CMV

EBV

Question 12

EBV –

where does this virus reside:

what other disease can be caused by this virus in the setting of immunosuppresion

Answer 12

Resides in B cells

May cause B cell lymphoma in the setting of NK and T cell immunosuppresion

Question 13

In general describe the beneficial outcomes of kindey transplant

who benefits the most from kidney tx?

Answer 13

if a patient is 20-25 yo and in ERSD, a kidney tx on average adds 45+ years to their life

15 years added for patients 60-65 yo

Question 14

which provides better outcomes, a kidney from a living donor or a decesaed donor?

Answer 14

Living Donor: – 12- 15 years

Deceased - 10 to 12 years