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Urology > Renal Replacement Therapy > Flashcards

Renal Replacement Therapy Flashcards

1
Q

What are the functions of the kidneys?

A 
Excretion of nitrogenous waste products
Maintenance of acid/base balance
Control of BP 
Drug metabolism and excretion 
Vitamin D activation 
Production of erythropoietin
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2
Q

When is CKD typically symptomatic?

A

At stage 4/5

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3
Q

What is uraemia?

A

The syndrome of advanced CKD

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4
Q

What is the earliest and most cardinal symptoms of uraemia?

A

Fatigue

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5
Q

What are the symptoms of CKD?

A

Typically asymptomatic until stage 4/5

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6
Q

When is RRT usually indicated with eGFR?

A

<10ml/min

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7
Q

What are indications for dialysis in ESRD?

A

Advanced uraemia, (GFR 5-10 ml/min)
Severe acidosis (bicarbonate <10 mmol/l)
Treatment resistant hyperkalaemia (K >6.5 mmol/l)
Treatment resistant fluid overload
Nephrologist’s clinical judgment is important

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8
Q

What are the types of RRT?

A

Renal transplant
Haemodialysis
Peritoneal dialysis
Conservative kidney management

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9
Q

What are the 2 types of haemodialysis?

A

Home

and satellite/hospital

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10
Q

What are the 2 types of peritoneal dialysis?

A

Continuous ambulatory peritoneal dialysis (CAPD)

Intermittent peritoneal dialysis (IPD)

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11
Q

What are the 2 molecular processes crucial for haemodialysis?

A

Ultrafiltration

Diffusion

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12
Q

Describe diffusion in haemodialysis

A

Process whereby solute composition of a solution A is altered by exposing solution A to solution B through a semi-permeable membrane
With time solution A equilibrates with solution B

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13
Q

Describe the process of ultrafiltration in haemodialysis/

A

Take the same semi-permeable membrane and apply a pressure gradient
to regulate fluid balance

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14
Q

Are ultrafiltration and diffusion applied at the same time or separately?

A

Same time

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15
Q

What are the pre-requisites for dialysis?

A

Semi-permeable membrane
Adequate blood exposure to membrane
Dialysis access
Anticoagulation

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16
Q

What are the permanent types of haemodialysis access?

A

Arteriovenous fistula

AV prosthetic graft

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17
Q

What are the temporary types of haemodialysis access?

A

Tunnelled venous catheter

Temporary venous catheter

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18
Q

What is an arteriovenous fistula?

A

When artery is anastomosed to a vein
Pressure is transmitted from artery to the vein causing hypertrophy
Has strong blood flow through it

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19
Q

When is AV prosthetic graft indicated?

A

In failed AV fistula

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20
Q

What is the disadvantages of AV prosthetic graft?

A

Foreign body

So increased risk of infectioqn

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21
Q

What direction does the dialysate move in?

A

Opposite to the blood flow to pull the solutes out of the blood

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22
Q

What is the fluid restriction in haemodialysis patients?

A

500-800ml/24 hours

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23
Q

What is the fluid restriction in peritoneal dialysis?

A

Usually more liberal as continuous ultrafiltration is often achieved

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24
Q

What restrictions are dialysis patients under?

A 
Fluid restriction 
Dietary restriction of 
Potassium 
Sodium 
Phosphate
25
Q

What are potential complications of haemodialysis?

A

CVS problems - arrhythmias, hypotension and cramps
Coagulation - clotting or heparin related problems
Other - allergic reactions to dialysis and tubing, catastrophic dialysis accidents

26
Q

What is the predominant home therapy for RRT?

A

Peritoneal dialysis

27
Q

What type of access is present in peritoneal dialysis?

A

Tunnelled cuffed catheter into the pelvic region

28
Q

How does peritoneal dialysis work?

A

Balanced dialysis solution is instilled into the peritoneal cavity using the peritoneal mesothelium as a dialysis membrane

29
Q

How does peritoneal dialysis control ultrafiltration?

A

Through glucose in the solution being an osmotic agent

Remember there is no pressure from the apparatus like in haemodialyis with the dialysis machine

30
Q

Describe CAPD peritoneal d?

A

Involves several exchanges of fluid throughout the day

31
Q

Describe APD peritoneal D?

A

Occurs at night with a machine

drains same amount of times but quicker with less filtration at each time

32
Q

What are the complications of peritoneal D?

A

Exit site infection
PD peritonitis
Ultrafiltration failure
Technical related problems - tube related or abdominal hernia

33
Q

What is the most commonest route of infection with gram positive PD peritonitis?

A

Skin contamination

34
Q

What is the commonest route of infection with gram negative PD peritonitis?

A

Bowel origin

35
Q

What other drugs should be considered in dialysis?

A

Erythropoietin injections
IV iron supplements for anaemia

  • Activated Vitamin D (eg calcitriol)
  • Phosphate binders with meals (CaCo3)for Vit D deficiency

Heparin

Water soluble vitamins

? antihypertensives

36
Q

Why does activated vitamin D have to be given in CKD?

A

Because activation of vitamin D occurs in the kidney

In cDK kidney not working so have to activate prior

37
Q

What considerations have to be made when putting a patient on dialysis?

A

Patient choice

Perceptions of effectiveness

38
Q

What are the limitations of dialysis?

A

It is a woeful substitute for the kidneys

39
Q

Where are kidney transplaneted?

A

Into the iliac fossa

40
Q

What is used as the membrane in peritoneal dialysis?

A

Peritoneal membrane

41
Q

What is the problem with using the peritoneal membrane for dialysis?

A

It does not apply pressure for ultrafiltration

42
Q

What happens to the native kidneys in transplantation?

A

They remain in situ

43
Q

How does cold ischaemic time of the kidney related to the success of the transplant?

A

The longer the cold ischaemia time - less successful

44
Q

What are potential surgical complications of renal transplant?

A 
Bleeding
Arterial thrombosis 
Venous thrombosis
Urine leak 
Hernia
Infection - more common
45
Q

What are the contraindications for renal transplant?

A

Cancer with metastases
Active infection
HIV with viral replication
Congestive heart failure

46
Q

What immunosuppression drugs are given after transplantation?

A 
Calcineurin inhibitors 
Anti-proliferative agents
mTOR inhibitors 
Glucocorticosteroids 
monoclonal antibodies
47
Q

What are the types of deceased donors?

A

Donation after brain death

Donation after cardiac death

48
Q

What are the types of living donors?

A

Living related donor

Living unrelated donor

49
Q

What is the criteria for brain death?

A 
Coma - unresponsive to stimuli 
Absence of cephalic reflexes
Apnoea of ventilator 
Body temperature above 34 degrees
Absence of drug intoxication
50
Q

What is paired donation?

A

When donor A want to donate to recipient B but is not an exact match
Donor B is in the same position with recipient B
Donor A is a match with recipient B and vice versa so switch

51
Q

What is pooled donation?

A

Pooled donation is where more than two pairs of donors and recipients are involved in the swap.

52
Q

Who is transplantation not usually suitable for?

A

Elderly

53
Q

What are the types of risk involved with transplantation?

A

Rejection
Infection
Malignancy
Delayed graft function

54
Q

How is rejection treated with?

A

High dose steroids and immunosuppression

55
Q

What are the two types of transplantation rejection?

A

Antibody mediated

Cell mediated

56
Q

What is cytomegalovirus?

A

Most important transplant related infection
Affects around 8% of transplant recipients
Despite prophylaxis treatment
high mortality and morbidity if left untreated

57
Q

What is the best way to treat ESRD?

A

Renal transplantation

58
Q

Are there enough donors for transplantation?

A

No demand is much higher than supply

59
Q

What are Extended criteria donors?

A

Donors with medical complexities
Donor aged >60yrs
Or donor aged 50-59 years with history of hypertension, death from cerebrovascular accident or terminal creatinine of >132umol/L

Urology (13 decks)

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