Renal Replacement Therapy Flashcards

1
Q

What is renal replacement therapy?

A

Dialysis

Kidney transplant

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2
Q

List 5 indications for renal replacement therapy.

A
Hyperkalaemia
Fluid overload
Uraemia
Acidosis
Presence of severe CKD symptoms
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3
Q

What are the 3 types of dialysis?

A

Haemodialysis (HD)
Peritoneal dialysis (PD)
Continuous veno-venous dialysis (CVVD)

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4
Q

Describe how haemodialysis is carried out. (3)

A
  1. Surgical arteriovenous fistula formation
    a. Takes 6-8 weeks to be ready for dialysis
    b. If no time for fistula formation, then use a tunneled line
  2. Blood is taken out of the patient
    a. Electrolytes diffuse out down a concentration gradient
    b. Fluid moves down an osmotic gradient via convection
  3. Blood is transfused back into the patient
    a. Dialysate is discarded
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5
Q

List 4 types of haemodialysis regimens.

Which one is standard?

A

Standard: 4 hours, 3 times a week

Other options:

  • 6 hours, 3 times a week
  • Short daily dialysis
  • Daily, overnight dialysis
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6
Q

List 8 complications of haemodialysis.

A
Hypotensive crash
Dialysis disequilibrium
Cramps
Fatigue
Hypokalaemia
Air embolism
Blood loss
Access problems
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7
Q

Describe the mechanism of peritoneal dialysis. (2)

A
  1. Dialysate is pumped into the peritoneal cavity; the peritoneal membrane acts as the semipermeable membrane between dialysate and blood
  2. Dialysate is rich in glucose, creating an osmotic gradient for fluid to diffuse out of blood
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8
Q

What are the 2 types of peritoneal dialysis? Briefly describe them.

A

Continuous ambulatory peritoneal dialysis (CAPD)
-Manual exchanges by patient

Automated peritoneal dialysis (APD)
-Machine exchanges dialysate automatically during sleep

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9
Q

List 7 complications of peritoneal dialysis.

A
Infection
Increased glucose load (diabetes)
Mechanical problems (e.g. hernia, diaphragmatic leak, dislodged catheter)
Peritoneal membrane failure
Hypoalbuminaemia
Encapsulating peritoneal sclerosis
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10
Q

List 4 contra-indications for peritoneal dialysis.

A

Grossly obese patients
Intra-abdominal adhesions
Frail patients
Unsuitable home environment

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11
Q

Which type of dialysis would you use in AKI? Why?

A

Haemodialysis

HD is immediate, whereas PD only has a gradual effect

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12
Q

What types of immunosuppression would you use in kidney transplants? (5)

A

INDUCTION:
Basilixumab
Alemtuzumab

MAINTENANCE:
Calcineurin inhibitors, e.g.
-Tacrolimus

Antimetabolites, e.g.
-Azathioprine

Prednisolone

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13
Q

List 7 surgical complications of kidney transplants.

List 4 transplant complications.

A
SURGICAL COMPLICATIONS:
Death
Major medical events
Bleeding
Thrombosis
Haematoma
Wound infection
Ureteric leak
TRANSPLANT COMPLICATIONS:
Delayed graft function (DGF)
Hyperacute rejection
Acute rejection
Chronic allograft nephropathy
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14
Q

Describe the 2 types of acute organ rejection.

A

Humoral (antibody-mediated)

Cellular

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15
Q

How would you treat acute organ rejection? (3)

A

IV methylprednisolone
Increase immunosuppression
Plasma exchange

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16
Q

Describe the pathophysiology of chronic allograft nephropathy. (2)

A
  1. Chronic, low-grade antibody response attacks the transplanted kidney
  2. Vascular changes damage the transplanted kidney
17
Q

How would you treat chronic allograft nephropathy? (1)

A

New transplant

18
Q

Which types of cancer are relatively more common in transplant patients (due to immunosuppression)? (2)

A
Lymphomas (post-transplant lymphoproliferative disorders)
Skin cancers (e.g. SCC, BCC)