Renal Replacement Therapy Flashcards
What is renal replacement therapy?
Dialysis
Kidney transplant
List 5 indications for renal replacement therapy.
Hyperkalaemia Fluid overload Uraemia Acidosis Presence of severe CKD symptoms
What are the 3 types of dialysis?
Haemodialysis (HD)
Peritoneal dialysis (PD)
Continuous veno-venous dialysis (CVVD)
Describe how haemodialysis is carried out. (3)
- 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 - Blood is taken out of the patient
a. Electrolytes diffuse out down a concentration gradient
b. Fluid moves down an osmotic gradient via convection - Blood is transfused back into the patient
a. Dialysate is discarded
List 4 types of haemodialysis regimens.
Which one is standard?
Standard: 4 hours, 3 times a week
Other options:
- 6 hours, 3 times a week
- Short daily dialysis
- Daily, overnight dialysis
List 8 complications of haemodialysis.
Hypotensive crash Dialysis disequilibrium Cramps Fatigue Hypokalaemia Air embolism Blood loss Access problems
Describe the mechanism of peritoneal dialysis. (2)
- Dialysate is pumped into the peritoneal cavity; the peritoneal membrane acts as the semipermeable membrane between dialysate and blood
- Dialysate is rich in glucose, creating an osmotic gradient for fluid to diffuse out of blood
What are the 2 types of peritoneal dialysis? Briefly describe them.
Continuous ambulatory peritoneal dialysis (CAPD)
-Manual exchanges by patient
Automated peritoneal dialysis (APD)
-Machine exchanges dialysate automatically during sleep
List 7 complications of peritoneal dialysis.
Infection Increased glucose load (diabetes) Mechanical problems (e.g. hernia, diaphragmatic leak, dislodged catheter) Peritoneal membrane failure Hypoalbuminaemia Encapsulating peritoneal sclerosis
List 4 contra-indications for peritoneal dialysis.
Grossly obese patients
Intra-abdominal adhesions
Frail patients
Unsuitable home environment
Which type of dialysis would you use in AKI? Why?
Haemodialysis
HD is immediate, whereas PD only has a gradual effect
What types of immunosuppression would you use in kidney transplants? (5)
INDUCTION:
Basilixumab
Alemtuzumab
MAINTENANCE:
Calcineurin inhibitors, e.g.
-Tacrolimus
Antimetabolites, e.g.
-Azathioprine
Prednisolone
List 7 surgical complications of kidney transplants.
List 4 transplant complications.
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
Describe the 2 types of acute organ rejection.
Humoral (antibody-mediated)
Cellular
How would you treat acute organ rejection? (3)
IV methylprednisolone
Increase immunosuppression
Plasma exchange