Renal replacement therapies

Question 1

Renal replacement therapy

Answer 1

Haemofiltration

Haemodialysis

Renal transplant

Question 2

Haemodialysis mechanism

Answer 2

Blood passed through a semi-permeable membrane

Dialysis fluid flows in the opposite dierction

Good for small solutes

Question 3

Complications of haemodialysis

Answer 3

Disequilibration syndrome

Hypotension

Access issues

Question 4

Access types for dialysis

Answer 4

Arteriovenous fistula

Tunnelled venous access line

Question 5

Arteriovenous fistula risks

Answer 5

Thrombosis

Steal syndrome

Stenosis

Question 6

Tunelled venous access line risks

Answer 6

Infection

Blockage

Recirculation of blood

Question 7

Disequilibrium syndrome

Answer 7

Neurologic sx due to cerebral edema

During or after intermittent hemodialysis

Question 8

Steal syndrome

Answer 8

Blood taken away, causing ishcaemia/necrosis

Question 9

Haemofiltration mechanism

Answer 9

Blood filtered against a highly permeable membrane

Both small and large solutes

Continuous

Question 10

How haemofiltration doesnt change BP drastically

Answer 10

Ultrafiltrate replaced by equal volume of fluid, so no change in BP

Question 11

Advantage of haemofiltration over dialysis

Answer 11

less significant fluid shifts

Reduced effect on BP

Question 12

Disavantage of filteration over haemodialysis

Answer 12

filtration:

• continuous
• slow at clearing solutes

Question 13

Peritoneal dialysis mechanism

Answer 13

pertoneum as a semi-permeable membrane

fluid injected through Tenckho catheter

can be done by patient

Question 14

Problems with peritoneal dialysis

Answer 14

peritonitis

exit site infection

loss of membrane function over time

Question 15

Long term risks of renal replacement therapy

Answer 15

CVS disease

Malnutrition

Renal bone disease

Raised amyloid

Malignancy

Infection

Question 16

Absolute CI to kidney transplant

Answer 16

Active infection

Cancer (unless >5yrs ago, and considered cured)

Severe comorbidity

Question 17

Types of donor grafts

Answer 17

DCD (donor after cardiac death)

DBD (brainstem death)

LD (Living donor)

Question 18

Risk with DCD grafts

Answer 18

Long warm ischaemia time

High risk of delayed graft function (unlike DBD)

Question 19

Immunosuppression phases

Answer 19

Induction

Maintenance

Question 20

Induction drugs

Answer 20

Basiliximab (anti-IL2)

Alemtuzumab (broad spectrum, allows steroid free maintenance)

Question 21

Maintenance drugs

Answer 21

Triple therapy:

Calcineurin inhibitors

Antimetabolite

Predniselone

Question 22

Calcineurin inhbitors eg

Answer 22

CIN

Tacrolimus

Ciclosporin

Question 23

Antimetabolite eg

Answer 23

Azothioprin

Mycophenolate

Question 24

Acute graft rejetion types

Answer 24

Humoral (Antibody-mediated)

Cellular (more common)

Question 25

Cellular graft rejection rx

Answer 25

IV methylpred Higher the dose of immunosuppression

Question 26

Humoral graft rejection Rx

Answer 26

IV methylpred Higher the dose of immunosuppression Plasma exchange

Question 27

Chronic allograft nephropathy (rejection) causes

Answer 27

low grade anti-body response CINs

Question 28

Chronic allograft nephropathy rx

Answer 28

Unresponsive to rx Progression may be slowed by switching from CINs to sirolimus

Question 29

SEs of CIN

Answer 29

tremor confusion

Question 30

SEs of ciclosporin

Answer 30

gum hypertrophy hirstuism

Question 31

SEs of antimetabolites

Answer 31

agranulocytosis hepatitis

Question 32

Immunosuppression infections

Answer 32

HSV CMV Candida Pneumocystis jirovecii