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P&T Block 5 Renal > L64 > Flashcards

L64 Flashcards

1
Q

AEIOU mnemonic for indications for renal replacement therapy

A 
Acidosis (metabolic)
HyperK refractory to treat
Intox - alc + drug intox
Overload - diuretics not working
Uremia
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2
Q

What is azotemia vs uremia?

A 
Azo = ↑BUN
Uremia = accum or uremic toxins, how renal failure presents clinically
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3
Q

Symptoms of uremia: what does the pt come in complaining about

A

Metallic taste
N/V
Confusion
Pruritis (itching)

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4
Q

Signs of uremia: what do you find on {E

A 
THINK ↑NH4
Asterixis
Myoclonic jerk
Seizures
Pericardial friction rub
Uremic frost: NH4 in sweat, covers skin
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5
Q

2 goals of dialysis

A

Remove 1. solutes (via diffusion) and/or 2. volume (via convection)

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6
Q

What is hemodialysis

A

Get large venous access - run blood through machine with diffusion membranes
Can do @ hospital or home

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7
Q

What settings make more efficient dialysis?

  1. Membrane type
  2. BF rate
  3. Duration of dialysis treatment
A
  1. High flux membrane = bigger pores
  2. High flow rate = better clearance
  3. Longer treatment
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8
Q

How is the effectiveness of a dialysis treatment measured?

A

Det by urea removal

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9
Q

Is dialysis solution usually ↑ or ↓ [electrolytes]?

A

↓ so create a [ ] gradient for excess in blood to flow out

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10
Q

What are the 3 access options hemodialysis?

A

AV fistula: connect AV to ↑size vein due to arterial pressure
AV graft: use basilic vein if veins are bad
Dialysis catheter: under skin into jugular vein

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11
Q

Which hemodialysis access option do you prefer?

A

Fistula - least complications, but takes a while to est

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12
Q

Biggest complication of dialysis catheters

A

Infection -> bactermia -> metastatic infection

  1. Coag neg Staph
  2. SA
  3. GNs
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13
Q

Common acute complications of dialysis

A

↓BP // headache
N/V
Muscle cramps
Chest pain

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14
Q

Rare acute complications of dialysis

A

Allergic rxn to filter
Dialysis disequilibrium syndrome - after 1st treatment, cerebral swelling b/c osmotic shifts after you took out volume too fast

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15
Q

Chronic complications of dialysis - which is most likely to cause mortality

A

Anemia (no EPO from kidney)
Renal osteodystrophy (↓active vit D)
CV disease = #1 cause mortality

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16
Q

Explain peritoneal dialysis

A

Peritoneum = filter
Osmotic agent in fluid = glucose (for fluid removal)
+ ↓ [fluid] - stays in abdomen so some period time
Remove and replace consistently

17
Q

Difference between continuous vs automated peritoneal dialysis

A 
Continuous = long dwell at night
Automated = long dwell during day
18
Q

Pros vs cons peritoneal dialysis

A

Pros: flexible, might help preserve remaining kidney fxn b/c no drastic vol changes
Cons: fluid 24/7, peritonitis

19
Q

Why dont you want peritoneal dialysis pts to get constipated?

A

Transbowel bacteria migration

↑risk peritonitis

20
Q

What is continuous renal replacement therapy? Which pts?

A

Slow, continuous dialysis

For unstable ICU pts - has better hemodynamic stability

21
Q

What is continuous veno-venous hemodialysis?

A

Hemodialysis but slower

22
Q

What is continuous veno-venous hemofiltration?

A

Remove excess fluid

Replace with fluid w/ bicarb to dilute BUN/Cr

23
Q

What is continuous veno-venous hemo-diafiltration?

A

Both hemodialysis + fluid removal/replacement

24
Q

Pros vs cons chronic renal replacement therapy?

A

Pros: more hemodynamic stability, good clearanceover time
Cons: can’t use for intox or hyperK (too slow), not great for electrolyte disorders, freq clotting

25
Q

What is the GFR for kidney transplant eligibility?

A

GFR

26
Q

Artery and vein the transplant kidney gets hooked up to

A

R iliac

27
Q

What is cross matching?

A

To det if recipient has Ab vs donor HLA
Add donor WBC + recipient serum Abs
If positive - stimulate complement = + cross match

28
Q

What is hyperacute rejection?

A

IMMEDIATE rejection
Less likely b/c do cross match
Not treatable

29
Q

What is acute cellular rejection?

A

T cell mediated

1st yr

30
Q

Symptoms of acute cellular rejection

A

USUALLY NOTHING + ↑Cr

Other: fever, enlarged kidney, ↓urine, ↑BP

31
Q

2 infections you’re worried about in a kidney transplant pt

A

CMV - neg recipient got pos donor

BK virus in IC pts (transplant recipients)

32
Q

BK virus causes what 2 things

A

Tubulo-interstitial nephritis

Ureteral stenosis

33
Q

What is post-transplant lympho-proliferative disorder?

A

EBV!!!!
B cell proliferation
Extranodal masses: GI, lungs, skin
+ Rituximab

P&T Block 5 Renal (30 decks)

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