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M - Urinary System (Liam Lennox) > Renal Replacement Therapy 1 > Flashcards

Renal Replacement Therapy 1 Flashcards

1
Q

What are functions of the kidneys?

A
  • Excretion of nitrogenous waste products
  • Maintenance of acid and electrolyte balance
  • Control of blood pressure
  • Drug metabolism and disposal
  • Activation of vitamin D
  • Production of erythropoietin
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2
Q

What does ESRD stand for?

A

Irreversible damage to kidneys affecting their ability to remove waste products, so to maintain life needs dialysis of kidney transplant

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3
Q

What is end stage renal disease (ESRD)?

A

Irreversible damage to kidneys affecting their ability to remove waste products, so to maintain life needs dialysis of kidney transplant

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4
Q

What are clinical features of advanced CKD?

A
  • Until CKD stage 4 or 5 may be asymptomatic
  • Syndrome of advanced CKD is called uraemia
  • Uraemic symptoms can involve almost every organ system but earliest symptoms are malaise and fatigue
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5
Q

What is the syndrome of advanced CKD called?

A

Uraemia

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6
Q

What eGFR indicates renal replacement therapy?

A

<10ml/min

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7
Q

What are some types of renal replacement therapy?

A
  • Renal transplant
  • Haemodialysis
    • Home haemodialysis
    • Satellite/hospital haemodialysis
  • Peritoneal dialysis
    • Continuous ambulatory peritoneal dialysis (CAPD)
    • Intermittent peritoneal dialysis (IPD)
  • Conservative kidney management
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8
Q

What does CAPD stand for?

A

Continuous ambulatory peritoneal dialysis

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9
Q

What does IPD stand for?

A
  • Intermittent peritoneal dialysis (IPD)
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10
Q

What is dialysis?

A

Process whereby the solute composition of solution A is altered by exposing solution A to solution B through a semipermeable membrane

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11
Q

What are the principles of dialysis?

A
  • Diffusion
  • Ultrafiltration
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12
Q

What are pre-requisites for dialysis?

A
  • Semipermeable membrane (artificial kidney in haemodialysis or peritoneal membrane)
  • Adequate blood exposure to the membrane (extracorporeal blood in haemodialysis, mesenteric circulation in PD)
  • Dialysis access (vascular in haemodialysis, peritoneal in PD)
  • Anticoagulation in haemodialysis
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13
Q

What are the different kinds of haemodialysis access?

A
  • Permanent
    • Arteriovenous fistula
    • AV prosthetic graft
  • Temporary
    • Tunnelled venous catheter
    • Temporary venous catheter
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14
Q

What are some restrictions for dialysis patients?

A
  • Fluid restrictions
    • Dictated by residual urine output
    • Interdialytic weight gain
  • Dietary restriction
    • Potassium
    • Sodium
    • Phosphate
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15
Q

What is peritoneal dialysis?

A

A balanced dialysis solution is instilled into the peritoneal cavity via a tunnelled, cuffed catheter using the peritoneal mesothelium as a dialysis membrane:

  • After a dwell time the fluid is drained out and fresh dialysate is instilled
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16
Q

What are different kinds of peritoneal dialysis?

A
  • Continuous ambulatory peritoneal dialysis (CAPD)
  • Automated peritoneal dialysis (APD)
  • Hybrid
17
Q

In peritoneal dialysis, what does the dialysate contain?

A

Balanced concentration of electrolytes

18
Q

In peritoneal dialysis, what is the most important agent for ultrafiltration of fluid?

A

Glucose

19
Q

How can peritoneal transport characteristics very?

A

Peritoneal transport characteristics can vary from high transporter to low transporter:

  • Dwell times can be adjusted according to transport characteristics
20
Q

What are some complications of peritoneal dialysis?

A
  • Exit site infection
  • PD peritonitis
    • Gram position – skin contaminant
    • Gram negative – bowel origin
    • Mixed – suspect complicated peritonitis such as perforation
  • Ultrafiltration failure
  • Encapsulating peritoneal sclerosis
21
Q

What are some indications for dialysis in ESRD?

A
  • Advanced uraemia (GFR 5-10ml/min)
  • Severe acidosis (bicarbonate <10mmol/L)
  • Treatment resistant hyperkalaemia (K>6.5mmol/L)
  • Treatment resistant fluid overload
22
Q

What are the fluid restrictions in haemodialysis?

A
  • Usually restricted to 500-800ml/24 hours intake allowed which is equal to urine output and insensible loss
23
Q

What are the fluid restrictions in peritoneal dialysis?

A
  • Usually more liberal intake as continuous ultrafiltration if often achieved
24
Q

What are some dialysis related drugs?

A
  • Anaemia
    • Erythropoietin injections
    • IV iron supplements
  • Renal bone disease
    • Activated vitamin D (eg calcitriol)
    • Phosphate binder with meals (CaCo3)
  • Heparin
  • Water soluble vitamins
25
Q

What are some complications of haemodialysis?

A

Cardiovascular problems:

  • Intra-dialytic hypotension and cramps
  • Arrhythmias

Coagulation:

  • Clotting of vascular access
  • Heparin related problems

Other:

  • Allergic reactions to dialysers and tubing
  • Catastrophic dialysis accidents (rare)
26
Q

What are some complications of peritoneal dialysis?

A

Infection:

  • Exit site infection
  • Tunnel infection
  • Peritonitis

Mechanical:

  • Tube malfunction
  • Abdominal wall herniae

Ultrafiltration problems

27
Q

How is the kind of dialysis choosed?

A

Patients choice:

  • Education
  • Shared decision making

Perceptions of effectiveness and cost

28
Q

How is conservative kidney management given for ESRF instead of dialysis?

A
  • Supportive care
    • Priority for symptomatic management
    • Holistic multi-professional approach
    • Anticipatory care planning

M - Urinary System (Liam Lennox) (29 decks)

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