Lecture 5 - Kidney Replacement Therapy

Question 1

Types of Renal Replacement Therapy

Answer 1

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

Question 2

Kidney Replacement Therapy Indications

Answer 2

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

Question 3

Renal Transplantation good?

Answer 3

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

Question 4

Conservative Management

Answer 4

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

Question 5

Dialysis

Answer 5

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

Question 6

How to keep things in blood

Answer 6

• Keep concentration same in dialysis as blood

Question 7

Toxins to be removed during kidney failure

Answer 7

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

Question 8

Problem with dialysis

Answer 8

• Infection
• Inconvenient

Question 9

Haemodialysis

Answer 9

• 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

Question 10

Home Haemodialysis

Answer 10

• 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

Question 11

Satellite Dialysis

Answer 11

• Small dialysis in community
• Cottage hospitals
• GP surgeries
• Nurses instead of doctors
• Patients who are relatively well

Question 12

Answer 12

• 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

Question 13

Pertioneal Dialysis

Answer 13

• 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

Question 14

Peritoneal Dialysis Pros and Cons

Answer 14

• 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

Question 15

Automated Peritoneal Dialysis (APD)

Answer 15

• 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

Question 16

Assisted APD

Answer 16

• Nurse comes and helps patient do it at home

Question 17

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Answer 17

• During day by keeping two litres of fluid in the abdomen at all times
• Exchanging the fluids four to six times per day

Question 18

Answer 18

• 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

Question 19

Answer 19

Question 20

Sources of Kidney Transplants

Answer 20

• 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

Question 21

Answer 21

• 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.

Question 22

Transplant Immunology

Answer 22

• 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.

Question 23

Complications with Transplant

Answer 23

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

Question 24

Transplant Prognosis

Answer 24

• Kidney lifespan:
• Deceased donor kidney 10 years
• Living donor 15 years

Question 25

Matching Donors

Answer 25

• 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

Question 26

Kidney Replacement Therapy Mortality

Answer 26