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Systems 2nd Year Renal > Renal Replacement Therapy > Flashcards

Renal Replacement Therapy Flashcards

1
Q

Which organ activates Vitamin D

A

Kidneys

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2
Q

Which organ produces erythropoietin

A

Kidneys

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3
Q

Until which stage of CKD may patient be asymptomatic

A

CKD Stage 4 or 5

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4
Q

What is advanced CKD called

A

Uraemia

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5
Q

Earliest Symptom of Uraemia

A

Malaise and Fatigue

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6
Q

When is Renal Replacement Therapy indicated

A

eGFR <10ml/min

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7
Q

Dialysis definition

A

Dialysis is a process whereby the solute composition of a solution, A, is altered by exposing solution A to a second solution, B, through a semipermeable membrane

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8
Q

Pre-Requisites for Dialysis

A
  1. Semipermeable Membrane (Artificial Kidney in Haemodialysis or Peritoneal Membrane)
  2. Adequate Blood exposure to membrane
  3. Dialysis Access
  4. Anticoagulation in Haemodialysis
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9
Q

What blood exposure to membrane does does haemodialysis need

A

extracorporeal blood

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10
Q

What blood exposure to membrane does Peritoneal Membrane need in renal replacement therapy

A

Mesenteric Circulation

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11
Q

What Dialysis access does Peritoneal membrane need in renal replacement therapy

A

peritoneal

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12
Q

What is permanent Haemodialysis access

A

AV Fistula

AV Prosthetic Graft

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13
Q

What are temporary Haemodialysis access measures

A

Tunnelled Venous Catheter and Temp Venous Catheter

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14
Q

Patients restrictions for dialysis

A

Fluid Restriction dictated by Residual Urine Output

Diet Restrict: Potassium, Sodium, Phosphate

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15
Q

What is used as dialysis membrane in peritoneal dialysis

A

Peritoneal Mesothelium

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16
Q

What is the most common osmotic agent for ultrafiltration of fluid in peritoneal dialysis

A

glucose

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17
Q

Peritoneal Dialysis Complications

A

Encapsulating Peritoneal Sclerosis

Ultrafiltration Failure

Gram Pos: Skin

Gram Neg: Bowel

Exit Site infection

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18
Q

Indications for Dialysis in End Stage Renal Disease

A
  1. Advanced Uraemia
  2. Severe Acidosis
  3. Treatment Resistance Hyperkalaemia
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19
Q

what is advanced uraemia staged as

A

GFR 5-10ml

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20
Q

severe acidosis classified as

A

bicarbonate <10mmol

21
Q

What are patients restricted to for fluids in Haemodialysis

A

500-800ml/24hours

22
Q

Dialysis Related Drugs for Anaemia

A

Erythropoeitin Injections

IV Iron Supplements

23
Q

Dialysis Related Drugs for Renal Bone Disease

A

Activated Vit D eg Calcitriol

Phosphate Binders with Meals

24
Q

Complications of Haemodialysis

A 
Arrythmias
Intra Dialytic Hypotension
Clotting
Heparin Related Problems
Exit Site infection
Tunnel Infection
Peritonitis
Hernias
25
Q

Renal Transplant where is transplanted kidney placed into

A

Iliac Fossa and Anastomosed to Iliac Vessels

26
Q

In renal transplant where do native kidneys go

A

Remain in Situ

27
Q

Indications for Native nephrectomy

A

Polycystic Kidney

Chronic Pyelonephritis

28
Q

What immunosuppressive agents can be used in Renal Transplant

A

Corticosteroid

Calcineurin Inhibitors eg Tacrolimus, Cyclosporine

29
Q

Side effects of corticosteroids in renal transplant

A 
hypertension
hyperglycaemia
infection
bone loss
gi bleed
30
Q

side effects of Tacrolimus in renal transplant

A

hyperglycaemia
AKI
tremor

31
Q

side effects of cyclosporin in renal transplant

A

Hirsutism
Hypertension
AKI
Gout

32
Q

Immunesuppression Protocols for Renal Transplant

A

Induction: Basiliximab
Maintain: Tacrolimus + Mycophenolate and Steroids

33
Q

Is the heart beating after cardiac death

A

No

34
Q

is the heart beating after brain death

A

Yes

35
Q

Brain death criteria

A 
Coma
Unresponsive to Stimuli
Apnoea off Ventilation
Absence Cephalic Reflexes eg Gag, Pupillary
Body Temp above 34
Absence of Drug Intoxication
36
Q

Expanded criteria for organ donation

A 
Donar >60
Donor 50-59
Hypertension History
Death from CVS Accident
Terminal Creatinine of >133
37
Q

What is associated with GFR of <60

A

Older Age and High BMI

38
Q

What mediates rejection after renal transplant

A

Cell Mediated

Humoral AB Mediated

39
Q

What malignancy can happen after renal transplant

A

Lymphoma

40
Q

Acute Rejection of Renal Transplant is mediated by

A

T cell

41
Q

Banff I Acute Rejection of Renal Transplant is categorised as

A

Tubulointerstitial or ATN Like

42
Q

Banff II Acute Rejection of Renal Transplant is categorised as

A

Arteritis/Endotheliatitis or Capillaries/Glomerular inflammation

43
Q

Banff III Acute Rejection of Renal Transplant is categorised as

A

Arterial Fibrinoid Necrosis or Arterial Inflammation

44
Q

Antibody Mediated Rejection of Renal Transplant shows what features

A

Microvascular Inflammation with Neutrophils, Glomeruli, Peritabular Capillaries
Donor Specific Antibodies
Positive C4d in Peritubular Capillaries

45
Q

What condition can happen after renal transplant

A

Diabetes Mellitus

46
Q

What is the most important transplant related infection

A

Cytomegalovirus

47
Q

Risk factors for BKAN after Renal Transplant

A

Immunosuppression

48
Q

Treatment for BKAN after Renal Transplant

A

Antivirals eg Cidofovir or Leflunomide

49
Q

Most common malignancy after renal transplant

A

Non Melanoma Skin
Kaosi Sarcoma
Non Hodgkin Lymphoma

Systems 2nd Year Renal (30 decks)

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