Renal 2 replacement therapy Flashcards
What are examples of renal functions? (4 points)
- Excretory function
- Water and electrolyte balance
- Acid base balance
- Renal endocrine function (erythropoietin, calcium metabolism, renin secretion)
Is renal dialysis an active or passive process?
PASSIVE process:
- Diffusion across concentration gradie nts
What is the purpose of dialysis?
Allows intermittent correction of changes in plasma concentration of small molecules
Is dialysis a renal replacement?
- No, not true replacement
- Significant lifestyle restrictions remain
What are the 2 types of renal dialysis?
- Haemodialysis
- Peritoneal dialysis
Where does haemodialysis occur?
- Outside the body
Where does peritoneal dialysis occur?
- Inside the body
How does the membrane in dialysis determine what can enter and leave the blood? (6 points)
- Membrane is like a bit of clingfilm with tiny holes in it
- Depending on the size of the holes in membrane can determine what gets through
- Can design membrane to allow electrolyte, protein and cell exchange
- Design solution on one side to be what you want to achieve on the other side
- Want to make a concentration gradient
- E.g. if want high Na+ in blood but have low content in blood then put high content in the fluid so will diffuse due to the concentration gradient
When using haemodialysis, why do we need to give the patient heparin?
- To stop the blood from clotting (anticoagulant)
What is a potential problem with peritoneal dialysis?
If get an infection of the peritoneum you have a serious problem
What are the advantages of peritoneal dialysis? (5 points)
- Can do this day and night
- Could put some in in the morning and take it out in the evening
- Could do only at night and cycle it quickly at night
- Because you can do it at home you can do it everyday
- If on peritoneal dialysis then can take your machine with you on holiday and all you need to get is the solution when you arrive at the destination
What is a disadvantage of peritoneal dialysis?
- Some patient’s don’t like the responsibility of being in charge of it (would rather go to the hospital to get it done)
What renal functions will dialysis restore? (3 points)
- Excretory function
- Water and electrolyte balance
- Acid base balance
How is erythropoietin replaced?
- By EPO injections
- Maintains red cell mass
How is bone mass function maintained? (2 points)
- Vit D supplementation
- Osteoporosis prevention programme
How can hypertension be controlled?
The renin-angiotensin system is inactive so ACE inhibitors may have limited use
What is the optimal treatment for end stage renal disease?
A transplant
Does a renal transplant give normal renal function?
Yes
Does a renal transplant give the patient any dietary restirctions?
no
Does a renal transplant give normal energy and fertility?
Yes
A renal transplant is a temporary fix, how long is it likely to last?
- 10-15 years
Why do you not need to remove the old kidneys when carrying out a renal transplant?
As the new kidney is placed in the pelvis as it is easier to place it there - easy to plumb into artery, vein, bladder
- However, this kidney is vulnerable to damage
What are possible problems with a renal transplant? (4 points)
- Rejection (acute or chronic)
- Immunosuppression (increased infection/malignancy risk)
- Higher CV mortality
- Osteoporosis risk
Is a renal transplant likely to last for longer is the donor is alive or dead?
Alive
When should you treat a patient with renal failure?
AFTER they have had their haemodialysis session
What should you do about drugs and people with renal failure?
Liase with their physicians
What are 4 drugs that a person with renal failure could be on that may interact or cause complications in dentistry?
- Prednisolone
- Azathioprine
- Tacrolimus
- Cyclosporin
Does renal treatment increase oral cancer risk?
- Yes, be suspicious of oral mucosal lesions
