Renal Replacement Therapy

Question 1

Where is transplanted kidney placed ?

Answer 1

Iliac fossa where it is anastamosed into iliac vessels

Question 2

What is indicative for a native nephrectomy to be carried out?

Answer 2

Polycystic kidneys - increase size

Infection

Question 3

What are complications of transplant surgery?

Answer 3

Bleeding, arterial thrombosis, venous thrombosis, lymphocele

Urine leak

Infection

Rejection

Question 4

Name some immunosupressive agents?

Answer 4

Corticosteroids, calcineurin inhibitors, anti-proliferative, mTOR inhibitors (sirolimus), costimulatory signal blockers, depleting agents

Question 5

What are the side effects of corticosteroids?

Answer 5

Hypertension, hyperglycaemia, infections, bone loss, GI bleeding

Question 6

What are side effects of tacrolimus?

Answer 6

Hyperglycaemia, AKI, tremor

Question 7

Name the side effects of cyclosporin?

Answer 7

Hirsuitism, hypertension, AKI, gout

Question 8

What are the side effects of sirolimus?

Answer 8

Lipodogenic, diabetogeinic, pneumonia

Question 9

What are the complications after renal transplantation?

Answer 9

Rejection

Infection

Cardiovascular - CRF, Hypertension, hyperlipidaemia, Post Trauma Diabetes

Malignancy

Question 10

What is cytomegalovirus?

Answer 10

A transplant related infection

Associated with high mortality and morbidity if untreated

It is either transmitted from donor tissue or reactivated from a latent state

Question 11

What is BK virus?

Answer 11

A branch of polyomaviridae

Question 12

What is the effect of BK virus on kidney transplant patients?

Answer 12

Manifests as Ureteral Stenosis, Intestinal Nephritis or ESRF

Question 13

What is the outcome of BK virus on kidney transplant patients?

Answer 13

Allograft dysfunction or loss of graft

Question 14

What is the treatment for BK virus?

Answer 14

Reduce immunosupression

Anti Viral Therapy

• cidofovir
• leflunomide

Question 15

What is end stage renal disease ?

Answer 15

Irreversible damage to a persons kidneys affecting their ability ro remove or adjust blood waste thus, to maintain life, they must have a kidney transplant

Question 16

What are the clinical features of CKD?

Answer 16

Until stage 4/5, patient is asymptomatic

Advanced CKD = Uraemia
- cardinal symptom = malaise and fatigue

Question 17

Name the types of renal replacement therapy

Answer 17

Renal transplant, haemodialysis, peritoneal dialysis, conservative kidney maagement

Question 18

When would conservative kidney management be an appropriate choice of treatment?

Answer 18

During end stage kidney disease when body isn’t coping with dialysis (i.e cardiovascular stress)

Permits more time at home for patient

Question 19

What is dialysis ?

Answer 19

a process by which solute composition of solution A is altered by exposure to solution B through a semi permeable membrane

Question 20

What are the access points for haemodialysis?

Answer 20

AV fistula/graft

Tunneled/temporary venous catheter

Question 21

What is the process of ultrafiltration?

Answer 21

Removal of excess fluid

Question 22

When are prosthetic grafts used ?

Answer 22

When blood vessels have calcified or when blood vessels are small

Question 23

What are the restrictions placed on dialysis patients?

Answer 23

Fluid restriction

• dictated by residual urine ouput
• interdialytic weight gain

Dietary Restriction
-Potassium
-Sodium
Phosphate

Question 24

What are the complications of peritoneal dialysis?

Answer 24

Exit site infection
PD peritonitis
Ultrafiltration failure
Encapsulating peritoneal sclerosis

Question 25

What is a gram positive cause of PD peritonitis?

Answer 25

Skin contaminant

Question 26

What is a gram negative cause of PD peritonitis?

Answer 26

Bowel origin

Question 27

What kind of bacteria would be found in peritonitis caused by perforation?

Answer 27

Mixed positive and negative

Question 28

What will dialysis patients develop in between dialysis?

Answer 28

Hyperkalaemia and acidosis

Question 29

What is the most common cause of death in dialysis patients?

Answer 29

CVD or infection

Question 30

Who would not benefit from Peritoneal Dialysis?

Answer 30

Patients with a decreased urine output

Question 31

What colour is PD fluid?

Answer 31

clear infection = cloudy

Question 32

What are indications for dialysis in ESRD?

Answer 32

Advanced uraemia, severe acidosis, treatment resistance hyperkalaemia, treatment resistant fluid overload

Question 33

What are complications from haemodialysis?

Answer 33

Cardiovascular problems - hypotension, cramps and arrythmias Coagulation - clotting of vascular access - heparin related problems Allergic reactions to dialysers and tubing

Question 34

What are complications of PD?

Answer 34

Infection - exit site infection, tunnel infection, peritonitis Mechanical -Tube malfunction, abdominal wall hernia Ultrafiltration problems