Renal replacement therapy Flashcards
Describe the function of kidneys in activating vitamin D
The kidneys convert vitamin D into calcitrol which is it’s active form - this is crucial for calcium absorption and maintaining phosphorus levels in out blood, this ensures strong healthy bones
Describe the production of erythropoetin
The kidneys produce erythropoetin which stimulates production of red blood cells in the bone marrow
This is important in maintaining adequate oxygen levels in the body
What is the definition of end stage renal disease
When there is so much damage to a person’s kidney that it impairs the usual function of excretion of waste and other functions which makes the patient require dialysis or transplant to live healthy
What is uraemia
The syndrome of advanced chronic kidney disease
What are the cardinal symptoms of uraemia
Malaise and fatigue although the symptoms can affect almost every organ
When is renal replacement therapy indicated
When eGFR is less than 10
What are the different types of renal replacement therapy
Transplant
Haemodialysis - most common
Peritoneal dialysis
Conservative kidney management
What is conservative kidney management
For very old, frail individuals , dialysis may cause more harm than good so it is better suited that their symptoms get treated with medication
Define dialysis
A process where the solute composition of a solution A is modified by exposing another solution to solution A through a semipermeable membrane
What is required for dialysis
Semipermeable membrane which is meant to act as the filtration system of the kidney
Adequate blood supply to the machine
Dialysis access
Anticoagulation in haemodialysis
Where is the dialysis access in haemodialysis compared to peritoneal dialysis
Hameodialysis - vascular access
Peritoneal dialysis - peritoneal access
What restrictions are in place for dialysis patients
Fluid restrictions and dietary restriction to limit electrolytes coming through the diet
What are complications of haemodialysis
Arrhythmias, hypotension and cramps
Issues with coagulation - clotting of the vascular access and issues with the heparin
What is the most common osmotic agent in peritoneal dialysis to be used for ultrafiltration
Glucose and it’s high osmolarity is used to pull fluid out towards it
What are the complications of peritoneal dialysis
Infections - risk of bactria getting into the tube during drainage
Peritonitis
Encapsulating peritoneal sclerosis
What is the symptoms of peritoneal dialysis (PD) peritonitis
Abdominal pain and cloudy urine
What is encapsulating peritoneal sclerosis
mesentery and peritoneum become thickened and calcified which causes abdominal pain and obstruction in the bowel - usually occurs in patients who have been on dialysis for more than 5 years
What are the indications for dialysis in end stage renal disease
Advanced uraemia - advanced CKD - GFR 5-10
Severe acidosis with bicarbonate less than 10 mmol/l
Hyperkalaemia and fluid overload which is treatment resistant
What drugs should be taken for anaemia associated with the iron loss caused by dialysis
Erythropoetin injections and IV iron supplements
What drugs should be given for renal bone disease associated with dialysis
Calcitrol (activated vitamin D)
Phosphate binders with meals
What anticoagulant is commonly given with dialysis
Heparin
What is ultrafiltration
Forcing fluid across the membrane to move some fluid out from the blood
