Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nephrology > Renal Replacement Therapy > Flashcards

Renal Replacement Therapy Flashcards

1
Q

What are patients GFRs usually at when they commence RRT

A

5-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Explain how haemodialysis (HD) works

A

blood passed over semi-permeable membrane against dialysis fluid flowing in opposite direction
Solutes diffuse across conc gradient
Hydrostatic gradient clears XS fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the preferred method of access in HD?

A

av fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How soon before HD should an av fistula be made and why?

A

8 weeks to avoid infection risk associated w central venous dialysis catheters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How often do HD patients have to dialyse and how long for?

A

3x a week or more for 3+ hrs at a time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the advantages of dialysing every day on HD?

A

increases does nd improves outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Can HD patients dialyse at home?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the problems associated w HD?

A
  1. ACCESS - AV fistula thrombosis, stenosis, steal syndrome
    Tunneled venous line infection, blockage or recirculation of blood
  2. DIALYSIS EQUILIBRIUM - cerebral oedema - neuro sx, start HD gradually
  3. Hypotension
  4. INFECTION at site
  5. ARRHYTHMIAS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Explain how peritoneal dialysis (PD) works

A

peritoneum is a semi-permeable membrane
Catheter is inserted in peritoneal cavity and fluid is infused
Solutes diffuse across slowly
Ultrafiltration - add osmotic agents (glucose, glucose polymers) to fluid
Continuous process w intermittent drainage + refilling of peritoneal cavity, performed at home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the problems associated w PD

A
  • catheter site infection or blockage
  • Peritonitis or sclerosing peritonitis
  • Hernia
  • Loss of membrane function over time
  • Constipation
  • Hypoglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is haemofiltration? When is it indicated?

A

Used in CCU when HD not possible due to low BP
Water is cleared by +ve pressure, dragging solutes into waste by convection
Ultrafiltrate (waste) replaced w volume of ‘clean’ fluid either before or after the membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the absolute contraindications to transplant?

A

cancer w mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the temporary contraindications to transplant?

A

active infection
HIV
unstable CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the relative contraindications to transplant?

A

CCF, CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the main types of kidney transplant?

A
  1. Living donor
  2. Deceased - brain death donor, expanded criteria donor (older kidney or pt w hx of CVA, BP or CKD), donor after cardiac death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the advantage of living donor transplant?

A

best graft function and survival, especially if HLA matched

17
Q

What does a donor after cardiac death transplant increase the risk of ?

A

delayed graft function

18
Q

What drugs are used in immunosuppression at the time of transplant? After?

A

monoclonal abs
after:
calcineurin inhibitors (tacrolimus, cyclosporin)
antimetabolites - azathioprine

19
Q

What drugs are used following acute rejection of transplant? what are the SE of these drugs that u need to be aware of?

A

Glucocorticoids
SE:
BP, hyperlipidaemia, DM, impaired wound healing, osteoporosis, cataracts, skin fragility

20
Q

What are the complications of transplant?

A
  1. Surgical - inf etc
  2. Delayed graft function
  3. Rejection
    i. acute - rx w high dose steroids + immunosuppression
    ii. chronic - progressive dysfunction
  4. Infection:
    - 1 month - hospital acquired/donor
    - 1-6 months - opportunistic therefore give CMV and pneumocystis jiroveci prophylaxis
    - 6-12 months - community acquired
  5. Malignancy - skin, post transplant lymphoproliferative disorder and gynaecologist
  6. CVD
21
Q

What are the overall complications of RRT

A
  1. Mortality: CVD (raised BP->Ca/PO4 dysregulation -> vascular stiffness ->inflammation ->oxidative stress ->abnormal endothelial function)
  2. Protein calorie malnutrition
  3. Renal bone disease - high turnover, renal osteodystrophy, osteitis fibrous
  4. Infection - uraemia -> granulocyte + T cell dysfunction w sepsis
  5. Amyloid - beta-2 microglobulin accumulation in long term dialysis -> carpal tunnel syndrome/ arthralgia

Nephrology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions