Renal Replacement Therapy Flashcards
What are some functions of the kidney?
Excretion of nitrogenous waste products Maintenance of acid and electrolyte balance Control of blood pressure Activation of vitamin D Production of erythropoietin Drug metabolism and disposal
What are the clinical features of advanced CRF?
Until the GFR declines to the 30ml/min rate the patient may be asymptomatic
The syndrome of advanced CFR is called uraemia
Uraemic symptoms can involve almost every organ system but the earliest and cardinal symptom are malaise and fatigue
What is renal replacement therapy?
The means by which life is sustained in patients suffering from end-stage renal disease
What is uraemia?
The syndrome of advanced CRF
What are the thee types of renal replacement therapy?
Haemodialysis
Peritoneal dialysis
Renal ransplant
What are the two types of peritoneal dialysis?
Continuous ambulatory peritoneal dialysis (CAPD)
Intermittent peritoneal dialysis (IPD)
What is dialysis?
A process whereby the dilute composition of a solution, A, is altered by exposing the solution A to a second solution, B, through a semipermeable membrane
What are the two principles of dialysis?
Diffusion
Ultrafiltration
What are the four pre-requisites for dialysis?
Semipermeable membrane (artificial kidney in haemodialysis or peritoneal membrane)
Adequate blood exposure to the membrane
Anticoagulation in haemodialysis
Dialysis access - vascular in haemodialysis, peritoneal in PD
What are the indications for commencing dialysis in ESRD?
Advanced uraemia, usually GFR 10ml/min
Severe acidosis
Hyperkalaemia
Fluid and salt retention not controlled with diuretics
What are the fluid restrictions for patients on dialysis?
500-800 ml/24hrs in haemodialysis, more liberal in
Give some of the drugs usually prescribed to patients on dialysis
Erythropoietin stimulating agent injections One alpha vit-D or calcitriol Phosphate binders with meals Iron supplements Water soluble vitamins
What are some complications of haemodialysis?
Clotting of vascular access Hypotension and cramps Cardiovascular problems Heparin related problems Allergic reactions to dialyses and tubing
What are some complications of peritoneal dialysis?
Peritonitis Exit site infection Tunnel infection Ultrafiltration problems Abdominal wall herniae
