L64 Flashcards
AEIOU mnemonic for indications for renal replacement therapy
Acidosis (metabolic) HyperK refractory to treat Intox - alc + drug intox Overload - diuretics not working Uremia
What is azotemia vs uremia?
Azo = ↑BUN Uremia = accum or uremic toxins, how renal failure presents clinically
Symptoms of uremia: what does the pt come in complaining about
Metallic taste
N/V
Confusion
Pruritis (itching)
Signs of uremia: what do you find on {E
THINK ↑NH4 Asterixis Myoclonic jerk Seizures Pericardial friction rub Uremic frost: NH4 in sweat, covers skin
2 goals of dialysis
Remove 1. solutes (via diffusion) and/or 2. volume (via convection)
What is hemodialysis
Get large venous access - run blood through machine with diffusion membranes
Can do @ hospital or home
What settings make more efficient dialysis?
- Membrane type
- BF rate
- Duration of dialysis treatment
- High flux membrane = bigger pores
- High flow rate = better clearance
- Longer treatment
How is the effectiveness of a dialysis treatment measured?
Det by urea removal
Is dialysis solution usually ↑ or ↓ [electrolytes]?
↓ so create a [ ] gradient for excess in blood to flow out
What are the 3 access options hemodialysis?
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
Which hemodialysis access option do you prefer?
Fistula - least complications, but takes a while to est
Biggest complication of dialysis catheters
Infection -> bactermia -> metastatic infection
- Coag neg Staph
- SA
- GNs
Common acute complications of dialysis
↓BP // headache
N/V
Muscle cramps
Chest pain
Rare acute complications of dialysis
Allergic rxn to filter
Dialysis disequilibrium syndrome - after 1st treatment, cerebral swelling b/c osmotic shifts after you took out volume too fast
Chronic complications of dialysis - which is most likely to cause mortality
Anemia (no EPO from kidney)
Renal osteodystrophy (↓active vit D)
CV disease = #1 cause mortality
Explain peritoneal dialysis
Peritoneum = filter
Osmotic agent in fluid = glucose (for fluid removal)
+ ↓ [fluid] - stays in abdomen so some period time
Remove and replace consistently
Difference between continuous vs automated peritoneal dialysis
Continuous = long dwell at night Automated = long dwell during day
Pros vs cons peritoneal dialysis
Pros: flexible, might help preserve remaining kidney fxn b/c no drastic vol changes
Cons: fluid 24/7, peritonitis
Why dont you want peritoneal dialysis pts to get constipated?
Transbowel bacteria migration
↑risk peritonitis
What is continuous renal replacement therapy? Which pts?
Slow, continuous dialysis
For unstable ICU pts - has better hemodynamic stability
What is continuous veno-venous hemodialysis?
Hemodialysis but slower
What is continuous veno-venous hemofiltration?
Remove excess fluid
Replace with fluid w/ bicarb to dilute BUN/Cr
What is continuous veno-venous hemo-diafiltration?
Both hemodialysis + fluid removal/replacement
Pros vs cons chronic renal replacement therapy?
Pros: more hemodynamic stability, good clearanceover time
Cons: can’t use for intox or hyperK (too slow), not great for electrolyte disorders, freq clotting
What is the GFR for kidney transplant eligibility?
GFR
Artery and vein the transplant kidney gets hooked up to
R iliac
What is cross matching?
To det if recipient has Ab vs donor HLA
Add donor WBC + recipient serum Abs
If positive - stimulate complement = + cross match
What is hyperacute rejection?
IMMEDIATE rejection
Less likely b/c do cross match
Not treatable
What is acute cellular rejection?
T cell mediated
1st yr
Symptoms of acute cellular rejection
USUALLY NOTHING + ↑Cr
Other: fever, enlarged kidney, ↓urine, ↑BP
2 infections you’re worried about in a kidney transplant pt
CMV - neg recipient got pos donor
BK virus in IC pts (transplant recipients)
BK virus causes what 2 things
Tubulo-interstitial nephritis
Ureteral stenosis
What is post-transplant lympho-proliferative disorder?
EBV!!!!
B cell proliferation
Extranodal masses: GI, lungs, skin
+ Rituximab
