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Urogenital Year 2 > Lecture 5 - Kidney Replacement Therapy > Flashcards

Lecture 5 - Kidney Replacement Therapy Flashcards

1
Q

Types of Renal Replacement Therapy

A

​

  1. Haemodialysis
  2. Renal Transplantation
  3. Peritoneal Dialysis
  4. Cosnervative Management
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2
Q

Kidney Replacement Therapy Indications

A
  • Cardiovascular Disease.
  • Acid-base disturbance
  • Hyperkalaemia
  • Anaemia
  • Pulmonary Oedema (due to fluid retention)
  • Chronic Kidney Disease Mineral and Bone Disorder.
  • GFR 15 or below
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3
Q

Renal Transplantation good?

A
  • Best form of renal replacement therapy.
  • Patients have best outcomes
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4
Q

Conservative Management

A
  • Supportive
  • Symptomatic control
  • Form of palliative care
  • More common in elderly
  • Can acheive similar prognosis to dialysis
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5
Q

Dialysis

A
  • Movement, via diffusion, of a solute from a high concentration to a low concentration across a semi-permeable membrane
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6
Q

How to keep things in blood

A
  • Keep concentration same in dialysis as blood
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7
Q

Toxins to be removed during kidney failure

A

​

  • Sodium
  • Potassium
  • Phosphate
  • Urea
  • Uraemic Toxins
  • Water
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8
Q

Problem with dialysis

A
  • Infection
  • Inconvenient
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9
Q

Haemodialysis

A
  • Blood dialysis
  • 3x a week
  • In hospital
  • Blood taken from patient into machine with dialysis membrane
  • 4-5 hour sessions
  • Dialysis fistula: joining artery and vein in arm where blood flow easily accessible.
  • 300-400 ml per min
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10
Q

Home Haemodialysis

A
  • Good:
  • More flexible
  • Less travel
  • Away from hospitals
  • Privacy
  • Can do every day for shorter courses
  • Shorter, more frequent sessions incr
  • Bad:
  • Complex procedure to learn
  • Plumbing / home conversion to accommodate it
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11
Q

Satellite Dialysis

A
  • Small dialysis in community
  • Cottage hospitals
  • GP surgeries
  • Nurses instead of doctors
  • Patients who are relatively well
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12
Q
A
  • Blood from patient enters full of uraemic toxins
  • Passes through dialyzer
  • Semi-permeable membrane
  • Toxins diffuse out
  • Negative pressure applied to dialysate
  • Ultrafiltration across membrane
  • Cleansed blood returns
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13
Q

Pertioneal Dialysis

A
  • Catheter in peritoneal cavity
  • Fluid into cavity
  • Dialysis across peritoneal membrane
  • Fluid drained out, and new put in
  • Fluid x4 a day
  • Fluid out = exchange 30 mins
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14
Q

Peritoneal Dialysis Pros and Cons

A
  • Good:
  • Home therapy
  • More mobile than home haemodialysis
  • Bad:
  • Finite time, the periotneal membrane wears out in 3-5 years
  • Used in patients who are fit and proposed for transplant, basically whilst waiting
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15
Q

Automated Peritoneal Dialysis (APD)

A
  • Dialysis takes place at night, during sleep, over 8-10 hours
  • The machine measures the fluids needed for each exchange and times the delivery of this carefully
  • The peritoneal cavity is filled with solution automatically
  • The waste solution is drained automatically
  • Fluid exchanges not usually needed during the day
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16
Q

Assisted APD

A
  • Nurse comes and helps patient do it at home
17
Q

Continuous Ambulatory Peritoneal Dialysis (CAPD)

A
  • During day by keeping two litres of fluid in the abdomen at all times
  • Exchanging the fluids four to six times per day
18
Q
A
  • Tube implanted in abdomen, stays there
  • Fluid fills up peritoneal cavity
  • Fluid remains in cavity for 4 hours
  • Reconnect, let fluid out
  • Put fresh fluid in
19
Q
A
20
Q

Sources of Kidney Transplants

A
  • Living:
  • Related
  • Altruistic
  • Deceased:
  • Extended criteria donors: patients who already had issues (second class organ)
  • Standard criteria donors: patients under 50 who died of brain damage etc
21
Q
A
  • Goes in pelvis
  • Subcuntaneously, easier to biopsy
  • Attach iliac vessels and ureter from bladder
  • Native kidneys left in
  • Adrenal gland is NOT transplanted from the new kidney.
22
Q

Transplant Immunology

A
  • Post transplant immunosuppression
  • Patients maintained on drugs to prevent rejection
  • Prevent T cell proliferation = prevents rejection
  • Increased risks of opportunitsitc infetions
  • Pneumocystis, affect lung = pneumonia
  • Cytomegalovirus, sometimes carried in donor kidney = causes hepatitis
  • Increased risk of malignancies, post-transplnat lympho-prolifary disease
  • Squamous cell carcinomas associated with.
23
Q

Complications with Transplant

A
  • Primary non-function, <1%
  • Cardiac
  • DVT
  • Pneumonia
  • 10% rejection
24
Q

Transplant Prognosis

A
  • Kidney lifespan:
  • Deceased donor kidney 10 years
  • Living donor 15 years
25
Q

Matching Donors

A
  • Collection of HLA antigens on donor and recipient
  • HLA - Human leukocyte antigen
  • A,B,D HLA types
  • 0, 1 or 2 mismatches etc
  • A3 - A3
  • B25 - B25
  • D3 - D4 = X
26
Q

Kidney Replacement Therapy Mortality

A

Urogenital Year 2 (3 decks)

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