Renal replacement therapies Flashcards
Renal replacement therapy
Haemofiltration
Haemodialysis
Renal transplant
Haemodialysis mechanism
Blood passed through a semi-permeable membrane
Dialysis fluid flows in the opposite dierction
Good for small solutes
Complications of haemodialysis
Disequilibration syndrome
Hypotension
Access issues
Access types for dialysis
Arteriovenous fistula
Tunnelled venous access line
Arteriovenous fistula risks
Thrombosis
Steal syndrome
Stenosis
Tunelled venous access line risks
Infection
Blockage
Recirculation of blood
Disequilibrium syndrome
Neurologic sx due to cerebral edema
During or after intermittent hemodialysis
Steal syndrome
Blood taken away, causing ishcaemia/necrosis
Haemofiltration mechanism
Blood filtered against a highly permeable membrane
Both small and large solutes
Continuous
How haemofiltration doesnt change BP drastically
Ultrafiltrate replaced by equal volume of fluid, so no change in BP
Advantage of haemofiltration over dialysis
less significant fluid shifts
Reduced effect on BP
Disavantage of filteration over haemodialysis
filtration:
- continuous
- slow at clearing solutes
Peritoneal dialysis mechanism
pertoneum as a semi-permeable membrane
fluid injected through Tenckho catheter
can be done by patient
Problems with peritoneal dialysis
peritonitis
exit site infection
loss of membrane function over time
Long term risks of renal replacement therapy
CVS disease
Malnutrition
Renal bone disease
Raised amyloid
Malignancy
Infection
Absolute CI to kidney transplant
Active infection
Cancer (unless >5yrs ago, and considered cured)
Severe comorbidity
Types of donor grafts
DCD (donor after cardiac death)
DBD (brainstem death)
LD (Living donor)
Risk with DCD grafts
Long warm ischaemia time
High risk of delayed graft function (unlike DBD)
Immunosuppression phases
Induction
Maintenance
Induction drugs
Basiliximab (anti-IL2)
Alemtuzumab (broad spectrum, allows steroid free maintenance)
Maintenance drugs
Triple therapy:
Calcineurin inhibitors
Antimetabolite
Predniselone
Calcineurin inhbitors eg
CIN
Tacrolimus
Ciclosporin
Antimetabolite eg
Azothioprin
Mycophenolate
Acute graft rejetion types
Humoral (Antibody-mediated)
Cellular (more common)
Cellular graft rejection rx
IV methylpred
Higher the dose of immunosuppression
Humoral graft rejection Rx
IV methylpred
Higher the dose of immunosuppression
Plasma exchange
Chronic allograft nephropathy (rejection) causes
low grade anti-body response
CINs
Chronic allograft nephropathy rx
Unresponsive to rx
Progression may be slowed by switching from CINs to sirolimus
SEs of CIN
tremor
confusion
SEs of ciclosporin
gum hypertrophy
hirstuism
SEs of antimetabolites
agranulocytosis
hepatitis
Immunosuppression infections
HSV
CMV
Candida
Pneumocystis jirovecii
