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Year 2 - Renal > Renal replacement therapy 1 + 2 > Flashcards

Renal replacement therapy 1 + 2 Flashcards

1
Q

• Describe the principles involved in renal replacement therapy and

A

The principles of surgical and medical management of renal transplantation including selection for renal transplant, medical and surgical complications will be described

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2
Q

Where is the new transplant kidney placed + what are its vessels anastomosed to

A

Iliac fossa

Vein joined to iliac vein
Artery joined to iliac artery
Ureter joined to bladder

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3
Q

Are the original damaged kidneys removed in renal transplant

A

No, left in place unless they’re going to interfere with transplant, e.g. if they’re causing repeated UTIs or persistent hypertension despite on drugs

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4
Q

Indications for nephrectomy before a renal transplant (usually the original damaged kidney is just left in place)

A

Big size - e.g. polycystic kidney disease

If they’re causing chronic urinary infections

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5
Q

Post transplant complications (4)

A

Bleeding or clotting of the anastomosed vessels

Leaking of ureter at the anastomosed site or blockage

Increased infection risk due to the need to take immunosuppressants to immune system rejecting kidney

Acute rejection

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6
Q

Long term immunosuppressants post transplant increases the risk of what malignancies (2)

A

skin - most common

lymphoma

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7
Q

Renal placement therapy involves either … or …

A

dialysis or transplant

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8
Q

List some immunosuppressant subtypes (4) used post-transplant and give an example of each

A

Corticosteroids - prednisone

Calcineruin inhibitors - tacrolimus, ciclosporin

Anti-proliferative - mycophenolate mofetil

mTOR inhibitors - sirolimus

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9
Q

Side effects of long term corticosteroid use post transplant

A

Hypertension
Hyperglycaemia
Bone disease
Increased infection risk

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10
Q

General side effects of any immunosuppressant

A

increased infection risk
Hypertension
GI discomfort
Weight change

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11
Q

The immunosuppression protocol pre and post post transplant consists of 3 groups of medications, what are they

A

Induction agent - used either before operation or immediately after

Maintenance agents - lifelong

Rejection agents - used specifically in treatment of rejection episodes

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12
Q

Types of transplant donors (3)

A

Deceased donors

  • donation after brain death
  • donation after cardiac death

Living donor

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13
Q

Traditional form of deceased organ donor are those that died from

A

brain death

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14
Q

The number of what form of deceased donor has been on the rise due to its better long term results

A

donation after cardiac death

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15
Q

How does paired exchange organ donation work

A

Donor A gives to recipient B, e.g. husband can’t give to their wife but can give to someone else (recipient B)

Donor B gives to recipient A, e.g. recipient B’s sister can’t give to them but can give to recipient A (donor A’s wife)

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16
Q

Kidney transplant is indicated in those with… (2)

A

End stage kidney disease on dialysis

Advanced CKD - stages 4 or 5

17
Q

Acute rejection may be suspected if blood level of what isn’t coming down

A

creatinine

18
Q

Acute rejection is usually asymptomatic and the attack on the kidneys is either mediated by … or …

A

T cells (cellular mediated)

Antibody mediated

19
Q

What endocrine disorder can develop as a side effect to all the immunosuppressants take post transplant

A

DM

20
Q

Most significant infection in post kidney transplant patients is

A

cytomegalovirus (a common virus that remains latent and asymptomatic once infected)

21
Q

Most significant infection in post kidney transplant patients is cytomegalovirus, the recipient is affected either by … or …

A

transmission from donor tissue

or

reactivation of latent virus within the recipient

22
Q

CMV infection post kidney transplant can manifest in 2 ways (one less serious than the other)

A

Typical viral infection - classic symptoms of fever, myalgia, malaise, fatigue

or

Tissue invasive disease - affecting specific organs

23
Q
  • Principles of dialysis and its main modalities

* state the social, economic and psychological implications of dialysis and renal transplantation.

A

.

24
Q

The syndrome of advanced CKD is called uraemia

Uraemic symptoms can involve almost every organ system but the earliest and cardinal symptoms are (2)

A

malaise + fatigue

25
Q

RRT is indicated when eGFR

A

10ml/min

26
Q

Modalities of dialysis

A

Haemodialysis

Peritoneal

27
Q

How does haemodialysis work

A

Blood is passed through the dialyser (semi-permeable membrane) which is constantly being bathed/pumped with dialysate fluid surrounding the dialyser

High conc. toxins/small solutes in blood move out into the dialysate fluid by passive diffusion, electrolytes in dialysate fluid will move into blood to equilibrate any differences

Filtered blood then returned to body via second needle

28
Q

How is haemodiafiltration different to haemodialysis

A

Haemodiafiltration uses CONVECTION (heat transfer due to bulk movement of molecules) rather than diffusion

Blood is passed through a high flux dialyser creating a high hydrostatic pressure which drives water and BOTH SMALL + LARGE solutes across the membrane into the dialysate fluid

However this means substitution fluid has to be infused into the blood at the same time to account for the high loss of water

29
Q

A semi-permeable membrane is required for dialysis; what is the semipermeable membrane in haemodialysis and peritoneal dialysis

A

Artificial kidney (artificial filter) made up fine hollow fibres with pores in their walls

Peritoneal membrane

30
Q

Haemodialysis requires vascular access - how may this be done (3)

A

Arteriovenous fistula - artery re-routed to join a vein

If vein too fragile/narrow then arteriovenous graft (synthetic tube used to join artery and vein)

If emergency, then temporary venous catheter placed into e.g. IJV in neck

31
Q

Restrictions for haemodialysis patients (2) - this doesn’t apply as much to peritoneal dialysis

A

Fluid restriction - depends on size + weight

Dietary restriction of Na+, K+, PO4^3-

32
Q

Complications of haemodialysis (4)

A

Hypotension
Arrythmias
Clotting of vascular access site
Allergic reaction to dialyser and tubing

33
Q

How does peritoneal dialysis work

A

Permanent catheter inserted into abdomen

Abdomen first filled with a bag of dialysate (high glucose content) then left for a few hours (DWELL TIME) where waste products and extra fluid pass through the peritoneum from blood into the dialysate, attracted by its high sugar content

Few hours later, old fluid is drained into a waste bad and fresh dialysate is instilled to repeat process

34
Q

2 types of peritoneal dialysis

A

Continuous Ambulatory Peritoneal Dialysis (CAPD) - manual exchange of fluid 4 times a day

Automated Peritoneal Dialysis (APD) - machine automatically performs a number of fluid exchanges while you sleep

35
Q

Complications of peritoneal dialysis (2)

A

Exit site infection

PD peritonitis

36
Q

Peritoneal dialysis relies on what process

A

ultrafiltration due to high glucose content of dialysate creating osmotic gradient for water to move into it from blood

37
Q

Requirements for haemodialysis (4)

A

Semipermeable membrane
Adequate blood exposure to the membrane
Vascular access - e.g. AV fistula/graft
ANTICOAGULATION

38
Q

People receiving haemodialysis may be on what medication (5)

A

Antihypertensives - beta blockers, CCBs, ACEI, ARBs

Diuretics

Anticoagulants - heparin

Phosphate binders - to lower blood phosphate and prevent bone disease

Erythropoietin stimulating agents/ iron supplements - to overcome anaemia

39
Q

Principle of haemodialysis v peritoneal dialysis

A

Haemo - diffusion

PD - ultrafiltration

Year 2 - Renal (21 decks)

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