Renal Replacement Therapy

Question 1

Where is the transplant kidney placed in the patient’s body?

Answer 1

Transplanted kidney is placed into the iliac fossa and anastomosed to the iliac vessels

Question 2

What are some indications that the native kidneys should be removed?

Answer 2

Indications for native nephrectomy include size (polycystic kidneys) and infection (chronic pyelonephritis)

Question 3

What are the brain death criteria?

Answer 3

Coma, unresponsive to stimuli 
Apnoea off ventilator (with oxygenation) despite build up of CO2
Absence of cephalic reflexes
pupillary
oculocephalic
oculovestibular (caloric)
corneal
gag
purely spinal reflexes may be present
Body temperature above 34 C
Absence of drug intoxication

Question 4

What are some types of living kidney donation?

Answer 4

Live related donor
Live unrelated donor (eg spousal)
Live unrelated donor – altruistic, non-directed
Paired / pooled
ABO incompatible / HLA incompatible

Question 5

What are some complications after a renal transplant?

Answer 5

Rejection
Cell mediated
Humoral (Ab mediated)

Cardiovascular
Underlying renal disease
CRF
Hypertension
Hyperlipidaemia
PT Diabetes

Infective
Bacterial
Viral
Fungal

Malignancy
Skin
Lymphoma
Solid Cancers

Question 6

What types of acute rejection are there?

Answer 6

T Cell Mediated Rejection- Tubulointerstitial (Banff I)
Arteritis/endothelialitis (Banff II)
Areterial fibrinoid necrosis (Banff III)
Acute Antibody Mediated Rejection- ATN-like (Banff I)
Capillaries and or glomerular inflammation (Banff II)
Arterial inflammation (Banff III)

Question 7

How is cytomegalovirus acquired after transplant?

Answer 7

Transmission from donor tissue

Reactivation of latent virus

Question 8

What is dialysis?

Answer 8

Dialysis is a process whereby the solute composition of a solution, A, is altered by exposing solution A to a second solution, B, through a semipermeable membrane.

Question 9

What are four prerequisites for dialysis?

Answer 9

Semipermeable membrane (artificial kidney in haemodialysis or peritoneal membrane)
Adequate blood exposure to the membrane (extracorporeal blood in haemodialysis, mesenteric circulation in PD)
Dialysis Access vascular in haemodialysis, peritoneal in PD
Anticoagulation in haemodialysis

Question 10

What are four types of haemodialysis access?

Answer 10

Permanent

• Arteriovenous fistula
• AV prosthetic graft

Temporary

• Tunnelled venous catheter
• Temporary venous catheter

Question 11

What are restrictions for dialysis patients?

Answer 11

Fluid restriction

• Dictated by residual urine output
• Interdialytic weight gain

Dietary restriction

• Potassium
• Sodium
• Phosphate

Question 12

What are three types of peritoneal dialysis?

Answer 12

Continuous Ambulatory Peritoneal Dialysis (CAPD),
Automated Peritoneal Dialysis (APD)
Hybrid

Question 13

What are four indications for dialysis in ESKD?

Answer 13

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

Question 14

What are dialysis related drugs for kidney patients?

Answer 14

Anaemia
-Erythropoietin injections
-IV iron supplements 
Renal Bone Disease
-Activated Vitamin D (eg calcitriol)
-Phosphate binders with meals (CaCo3)
Heparin
Water soluble vitamins 
Antihypertensives

Question 15

What are complications of haemodialysis?

Answer 15

Cardiovascular problems
-Intra-dialytic hypotension and cramps
-Arrhythmias
Coagulation
-Clotting of vascular access
-Heparin related problems
Other
-Allergic reactions to dialysers and tubing
-Catastrophic dialysis accidents (rare)

Question 16

What are complications of peritoneal dialysis?

Answer 16

Infection
-Exit site infection
-Tunnel infection
-Peritonitis
Mechanical
-Tube malfunction
-Abdominal wall herniae
Ultrafiltration problems