renal replacement therapy

Question 1

dialysis

Answer 1

uraemic toxins efficiently removed from the blood by process of diffusion across a semipermeable membrane towards low concentrations in dialysis fluid

Question 2

what leaves the blood in dialysis

Answer 2

potassium, urea and water

Question 3

what doesnt leave the blood in dialysis

Answer 3

calcium - stays same
sodium - stays same
HCO3- - comes in to the blood

Question 4

haemodialysis

Answer 4

artero-venous fistula in forearm
3 x a week
pts anticoagulated w heparin during rx

Question 5

most common acute complication of haemodialysis

Answer 5

hypotension caused in part by XS removal of extracellular fluid

Question 6

peritoneal dialysis

Answer 6

permanent tube (Tenckoff catheter) placed into peritoneal cavity via subcut tunnel
can be done at night or continuously throughout the day

Question 7

most common serious complication of peritoneal dialysis

Answer 7

bacterial peritonitis often with staph epidermidis

rx w appropriate ABx often given intraperitoneally

Question 8

complications of LT dialysis

Answer 8

CV disease as a result of atheroma and sepsis = leading causes of death
causes of fatal sepsis = peritonitis & staph aureus infec
amyloidosis due to accumulation of B2-microglobin

Question 9

What is B2-microglobin

Answer 9

a component of human leucocyte antigen proteins on most cell membranes
usually excreted by kidneys but is not removed by dialysis membranes - its too big
deposition = carpal tunnel sydrome & joint pains

Question 10

kidney transplant

Answer 10

rx of choice in end stage renal failure
graft survival 80% at 10y
ABO, HLA match req
donor kidney place in left iliac fossa
LT immunosuppressants

Question 11

complications transplant

Answer 11

opportunistic infection
HTN
tumour development

Question 12

drugs given renal transplant

Answer 12

corticosteroids
azothioprine (immunosuppressant) 
ciclosporin (immunosuppressant) 
tacrolimus (immunosuppressant) 
monoclonal antibodies such as antilymphocyte globulin = potent immunosuppressant

Question 13

benefits haemodialysis

Answer 13

live alone / frail
fear of operating machines
unsuitable for PD: abdo surgery, abdo hernia, recurrent PD peritonitis, lack of space at home

Question 14

benefits peritoneal haemodialysis

Answer 14

young / full time work
wanting control of own care
lack of suitable access for HD
severe HF

Question 15

indications for renal replacement in AKI

Answer 15

hyperkalaemia
metabolic acidosis
pulmonary oedema
uraemic pericaditis 
severe uraemia

Question 16

renal allograft rejection

Answer 16

hyperacute - preformed antibodies that recognise HLA in donor organ = immediate
acute - mediated by t lymphocytes in first 6 mo - manifests as an inc in serum creatinine
chronic - slow decline in renal function - usually more than 6 mo after transplant - proteinurea