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Renal 2020 > Renal Replacement Therapies > Flashcards

Renal Replacement Therapies Flashcards

1
Q

two types of renal replacement therapies

A
  1. dialysis

2. transplant

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2
Q

what does dialysis do?

A

removes urea, K+ and Na+ while infusing bicarbonate

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3
Q

two types of dialysis

A
  1. haemodialysis

2. peritoneal dialysis

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4
Q

describe HD

A

solutes are dragged across a semi-permeable membrane in response to a pressure gradient (ultrafiltration)

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5
Q

routine of HD

A

going to hospital for 4 hours, 3 times a week

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6
Q

what does HD require?

A

vascular access

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7
Q

two vascular access options for HD

A
  1. fistula

2. tunnelled venous catheter

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8
Q

what is a fistula in terms of HD?

A

artery and vein connected creating an enlarged vein (AVF)

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9
Q

potential sites for a fistula in HD

A

radio-cephalic (RC AVF)
brachio-cephalic (BC AVF)
brachio-basilic transposition (BB AVF)

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10
Q

benefits of fistula

A

less likely to cause infection

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11
Q

consequences of fistula

A

requires surgery
maturation 6-12 weeks
can reduce blood flow to distal arm

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12
Q

what is a tunnelled venous catheter?

A

catheter into a large vein (IJV)

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13
Q

benefits of tunnelled venous catheter

A

use immediately

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14
Q

risks with a tunnelled venous catheter

A

infection

blockage

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15
Q

what does peritoneal dialysis use?

A

peritoneal membrane

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16
Q

benefit of PD over HD

A

can be done at home

17
Q

two types of peritoneal dialysis

A
  1. continuous ambulatory peritoneal dialysis (CAPD)

2. automated peritoneal dialysis (APD)

18
Q

what does CAPD use?

A

4 x 2L bag exchanges per day

19
Q

what does APD use?

A

1 bag all day and overnight machine drainage

20
Q

risks in PD

A

infection (exit site or gut bacteria)
peritoneal membrane failure
hernia (increased abdominal pressure)

21
Q

complications of dialysis

A

hypotension
haemorrhage (ruptured AVF)
arrhythmias (electrolyte imbalances)

22
Q

what is intra-dialytic hypotension?

A

myocardial stunning after removal of large volumes of H2O leading to underfilling of intravascular space and low BP

23
Q

indications that dialysis should be started

A 
resistant hyperkalaemia
eGFR <7ml/min
urea >40mmol/L
unresponsive metabolic acidosis
symptomatic (itch, nausea, anorexia, fatigue, fluid overload)
24
Q

criteria for transplant recipients

A

life expectancy >5 years

be able to survive the operation

25
Q

what must be checked in the patient and donor before the transplant?

A 
immunology e.g. tissue typing- blood group and HLA
antibody screen
virology
cardiorespiratory
peripheral vessels
bladder function
mental state
co-morbidities
26
Q

additional test in donor?

A

physical fitness assessment to live with only one kidney

27
Q

describe the surgical procedure of a kidney transplant

A

extraperitoneal procedure that inserts the transplant into the iliac fossa and attaches to the external iliac’s with ureter into the bladder

28
Q

three lengths of time it can take the kidney to work

A
  1. immediate graft function
  2. delayed graft function
  3. primary non-function (never works)
29
Q

how long does delayed graft function take to work?

A

10-30 days

HD in interim

30
Q

types of transplant rejection

A
  1. hyperacute
  2. acute
  3. chronic rejection
31
Q

what is required in hyperacute rejection?

A

nephrectomy

32
Q

what is required in acute rejection?

A

increase immunosuppression

33
Q

what is chronic rejection?

A

slow decline in function

34
Q

immunosuppressants used in transplant patients

A

basiliximab/dacluzimab (monoclonal antibodies blocking IL-2 on CD4)
prednisolone
tacrolimus
ciclosporin (calcineurin inhibitors inhibit T cells)
MMF
azathioprine (anti-metabolites block purine synthesis and proliferation of lymphocytes)

35
Q

what virus is associated with early graft loss in the first 3 months?

A

CMV

36
Q

management of CMV in transplant patient

A

valganciclovir (prophylaxis)

ganciclovir (if infection)

37
Q

risks with immunosuppression

A

BK nephropathy
non-melanoma skin cancer
lymphoma (EBV)

Renal 2020 (26 decks)

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