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BDS2 BAMS > Renal Replacement > Flashcards

Renal Replacement Flashcards

1
Q

4 renal functions

A

excretory function

water and electrolyte balance

acid base balance
- compensate with ventilation partly

renal endocrine function

  • erythropoietin – RBC
  • calcium metabolism – vit D production of Ca Metabolism
  • renin secretion
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2
Q

how are renal endocrine functions dealt with in renal failure

A

medically - with injections

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3
Q

how are renal excretory, water and electrolyte and acid base balance functions dealt with in renal failure

A

with renal replacement

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4
Q

what type of process is renal dialysis

A

passive

diffusion down concentration gradient

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5
Q

what does the dialysis machine facilitate in renal replacement

A

Allows intermittent correction of changes in plasma concentration of small molecules

Blood with desired and undesired components
- Thin membrane
Causing undesired to move out and more desired to move in

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6
Q

what impact does renal dialysis have on the pt lifestyle

A

significant restrictions remain

Not connected 24/7
- Stop dialysis get worse again
- Build up until plugged in again
- Tends to affect how pt feels - up and down
Keep blood at tip top all the time
- Better than no kidney function
- Any water that you take in as to go out through dialysis

Restricted in types can eat and fluid drink. As only up to limit by what is achieved by dialysis

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7
Q

where does haemodialysis occur

A

outside the body

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8
Q

where does peritoneal dialysis occur

A

inside the body

using peritoneum as dialysing machine

Peritoneum (gut bag), exposed thin layer of BV
- Machine into meet the blood rather than blood out to

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9
Q

what are the 2 types of dialysis

A

heamodialysis and peritoneal dialysis

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10
Q

what do you need to do to a body’s circulatory system to perform heamodialysis

A

Need to short circuit some body’s system so faster

  • Pressure in artery high, vein low
  • Lots of blood through loop

Vein increases
- Easier to out cannula in
- Suitable access point for dialysis
Undergo diffusion process in machine

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11
Q

what do you need to add to blood to prevent it clotting in the haemodialysis machine

A

heparin

so blood become anti-coagulated
- passes down through the dialyser

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12
Q

what is the dialyser tube like

A

Filled with tubes surrounded by dialyising solution

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13
Q

what do the thin membranes of the dialyser tube permit

A

thin membranes maximise area between dialysing solution and blood

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14
Q

what influences the time between dialysis and no dialysis in haemodialysis

A

Cycle of dialysis and no dialysis

Time between depends on kidney function level
- Can be overnight - infection control issue for haemodialysis
so less common

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15
Q

what additional modifications to you need on a haemodialysing machine so it works effectively

A

Heaters to warm up solution

Traps to prevent air in

pumps to keep pressure

heparin for anti-coagulation

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16
Q

what is a basic description of the process of dialysis

A

Purely passive diffusion down to concentration gradients between blood and dialysing solution

Effectively like clingfilm with tiny holes in it
- Depending on size of hole in that membrane
- Too large to let big ions through
Design membrane to allow electrolyte exchange, protein exchange

Design dialysing solution on one side to be what you want to achieve on the other (blood)

  • Create a concentration gradient for ions to move in/or of blood
  • Dialysing solution should be opposite of blood
  • –High in solution - move in
  • –Low in solution - move out of blood
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17
Q

how should you design the dialysing solution

A

Design dialysing solution on one side to be what you want to achieve on the other (blood)

  • Create a concentration gradient for ions to move in/or of blood
  • Dialysing solution should be opposite of blood
  • –High in solution - move in
  • –Low in solution - move out of blood
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18
Q

what should the dialysing solution be compared to blood

A

opposite of what you want the blood to be

19
Q

peritoneal dialysis process

A

Surface of bowel loops hasn’t got epithelial covering on it
- Behave like dialysing straws -enough diffusion occurring

Fluid into peritoneum not machine
- Sealed bag with intestines on inside
- Tube in - fluid stay as sealed off
Stay around outside of gut loops

After a while chance to equilibrate
Inside body rather than outside in machine

Suck into drainage contained – back out

20
Q

what is the tube like in the implanted catheter

A

like a leaky garden hose

21
Q

where is the implanted catheter positioned

A

Positioned inside peritoneum

Bath peritoneal cavity

22
Q

3 advantages of peritoneal dialysis

A

Different patterns to use

  • Can do day and night
  • Can do at side of bed - no blood tubes
  • Can do only at night

Can do at home so can do every day

  • Meaning no bad days
  • Mimics more natural kidney condition
Machine can go in suitcase
- All need bags of fluid 
- More flexible system 
- More able to travel and work 
Overnight dialysis
23
Q

disadvantage of peritoneal dialysis

A

In charge of own life/death

- Lots of responsibility on pt - May dislike

24
Q

disadvantage of haemodialysis

A

Cannot go away for a day

- Otherwise needs to go to a place where hospital able to do dialysis and spend lots of time on dialysis

25
Q

what is the main drawback of both types of dialysis

A

Dialysis is not cure
- way of staying alive

Restricted to fluid that can take in (1l a day)
- Used for everyday - swallow, dry mouth restricted hydration and food intake level

Less so with peritoneal dialysis

26
Q

how do you replace erythropoietin in renal failure

A

replaced by EPO injections

- maintains RBC mass

27
Q

how do you ensure bone mass maintenance in renal failure

A

Vitamin D supplementation (stopped production)

Osteoporosis prevention programme

28
Q

how do you control hypertension in renal failure

A

Renin-angiotensin system inactive (stopped renin secretion)

Ace inhibitors may have limited use

29
Q

what is the next treatment step after dialysis

A

transplantation

30
Q

why is dialysis not ideal for children

A

Dialysis will keep you ticking along
- But not support in growth

Issue in children
- Not puberty as normal
High priority for transplant

31
Q

what is the optimal treatment for end stage renal disease

A

renal transplantation

32
Q

what does renal transplantation restore

A

normal renal function

no dietary restrictions normal energy and fertility

33
Q

why is there a waiting list for renal transplantations

A

Shortage of donor organs
- Usually trauma organs

May be family
- Don’t donate at beginning as increase with age less likely to get donation with age

Live donor more successful than deceased

34
Q

is renal transplant a cure for kidney disease

A

no - temporary fix

Then need another transplant
- Less chance on second time of getting

Graph gets attacked by immune system and renal functions fail again
- Like chronic renal failure
Usually trauma organs

35
Q

what happens to the non-functioning kidneys in renal replacement

A

left in - hard to access

36
Q

where is the replacement kidney placed in the body

A

Put transplant in pelvis

Where appendix is
- Easy to connect to artery and ureter

Issue as vulnerable to contact sports

37
Q

what has the better survival rate - renal dialysis or transplant

A

renal transplant

38
Q

what are the 4 possible renal transplant problems

A

Rejection

  • acute or chronic
  • Immune system takes a dislike to it

immunosuppression
- increased infection/malignancy risk

high cardiovascular mortality

  • ? An effect of transplant
  • ? Aetiological in renal disease

Osteoporosis risk

39
Q

how can renal transplant increase osteoporosis risk

A

Bone loss greater with time since transplant

  • Manageable with mx
  • vit D supplementation
40
Q

what could be a reason for quick rejection of renal transplant

A

Can happen very fast

  • —Identifies as foreign
  • —Attacks and destroys it
41
Q

what could be reason for long term rejection of renal transplant

A

Can happen over years

- Medication stops immune attacking new kidney

42
Q

does a deceased or alive donor have increased survival chance for renal transplant

A

Less success rate from deceased donor
- 75% compared to 90%

Usually due to more time out of body so more time to be traumatised

43
Q

dentistry and renal disease (5 factors)

A

treat after haemodialysis sessions

  • not necessary for Peritoneal Dialysis patients
  • Most able to accept tx
  • But not on day - as anticoagulants so may effect tx
  • —Best is day following dialysis session

liase with physicians for drugs
- DO NOT use the dialysis shunt - Patient’s lifeline!
- Medicine needs to be excreted in dialysis
need to be sure before give
speak to renal physician so doesn’t accumulate in the body

No heroic treatment plans

  • Patient may not be able to cope with complicated treatment sessions
  • Can it wait whilst they are on dialysis?

normal renal function at first may reduce with time

  • Check creatinine levels
  • Chronic renal failure
  • —-Kidney function drops

complications are those of immune suppressants

44
Q

steroid side effects

A

increased cancer risk

- be suspicious of oral mucosal lesions

BDS2 BAMS (54 decks)

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