Renal failure

Question 1

Uraemia, protein loss and Na retention, acidosis, hyperkalaemia, anaemia and vitamin D deficiency

What are you thinking of?

Answer 1

Renal failure

Question 2

what are some signs and symptoms of uraemia?

Answer 2

pruritus, NV, anorexia, wt loss, lethargy, confusion, restless legs, neuropathy, metallic taste, bleeding
pale, striae, pericardial or pleural rub, fits, coma

Question 3

what are some signs and symptoms of protein loss and Na retention?

Answer 3

polyuria, polydipsia, oliguria, anuria, SOB

oedema, increased JVP, HTN or hypotension

Question 4

what are some signs and symptoms of Acidosis?

Answer 4

SOB, confusion

kussmauls respiration

Question 5

what are some signs and symptoms of hyperkalaemia?

Answer 5

palpitations, chest pain, weakness

Peaked T waves, flattened P waves, increased PR interval, widened QRS, sine-wave pattern leading to VF

Question 6

what are some signs and symptoms of anaemia?

Answer 6

lethargy, SOB, faintness, tinnitus

pallor, tachycardia, flow murmurs (ESM at apex)

Question 7

what are some signs and symptoms of Vitamin D deficiency?

Answer 7

bone pain, fractures

osteomalacia–>looser’s zones (pseudo fractures), cupped metaphyses

Question 8

what is an AV fistula?

Answer 8

a surgically constructed connection between an artery and a vein

Question 9

what is an AV fistula used for?

Answer 9

it is used in haemodialysis as the main point of catheter access as it allows large amounts of blood to flow during a dialysis treatment.

Question 10

how does an AV fistula form?

Answer 10

the arterial pressure enlarges/dilates the vein and causes thickened vessel walls able to withstand frequent puncture.

Question 11

how does haemodialysis work?

Answer 11

a machine is used to pump blood through an artificial filter to enable removal of waste products and fluid. purified blood is then pumped back into the AV fistula into circulation

Question 12

how does haemodialysis differ from haemofiltration?

Answer 12

haemodialysis involves the movement of solutes by diffusion across a semipermeable membrane whereas haemfiltration involves the movement of solutes by convection across a pressure gradient (positive hydrostatic pressure is used to drive the solutes and water across the membrane)

Question 13

is haemodialysis or heamofiltration better at removing medium-large molecules from the blood?

Answer 13

haemofiltration

Question 14

what acts as the semipermeable membrane in peritoneal dialysis?

Answer 14

the peritoneum!

Question 15

what are some contraindications to peritoneal dialysis?

Answer 15

unsuitable peritoneum due to adhesions, fibrosis or malignancy

Question 16

why would peritoneal dialysis be used instead of haemodialysis?

Answer 16

it is preferred in patients that want to carry out their normal daily activities. there are fewer restrictions on diet and fluid intake. it puts less strain on the heart
used in infants and young children and inn those who have limited options for vascular access.

Question 17

what are some post op complications of a renal transplant?

Answer 17

bleeding
graft thrombosis
infection
urinary leaks

Question 18

what occurs in hyperacute rejection of renal transplant?

Answer 18

occurs after minutes of transplant
ABO incompatibility
thrombosis and SIRS

Question 19

what occurs in acute rejection of renal transplant?

Answer 19

occurs within 6months
rising creatinine with or without fever and graft pain
cell mediated response
responsive to immunosuppression

Question 20

what occurs in chronic rejection of renal transplant?

Answer 20

occurs after 6months
interstitial fibrosis and tubular atrophy
gradual increase in creatinine and proteinuria
not responsive to immunosuppression

Question 21

cyclosporin and tacrolimus can cause nephrotoxicity. what happens in acute nephrotoxicity?

Answer 21

reversible afferent arteriole constriction leading to decreased GFR

Question 22

cyclosporin and tacrolimus can cause nephrotoxicity. what happens in chronic nephrotoxicity?

Answer 22

tubular atrophy and fibrosis

Question 23

what are the differentials for rising creatinine in a renal transplant patient?

Answer 23

rejection
obstruction
ATN
drug toxicity