Renal Replacement Therapy

Question 1

Indications for RRT

Answer 1

Acute:
Acidosis
Electrolyte disturbance: potassium over 7, ECG changes
Intoxication: aspirin
O Refractory Pulmonary Oedema
Uraemia (pericarditis [CF: chest pain relieved by sitting forward] and encephalopathy)

Chronic:
eGFR <15

Question 2

Types

Answer 2

Haemodialysis

Haemofiltration

Peritoneal Dialysis

Renal Transplant

Question 3

Haemodialysis

Procedure

Answer 3

Central Venous Catheter or AV fistula

3 hours: 3 x a week

AV fistulae needs anticoagulation

Question 4

Haemodialysis complications

Answer 4

Failure of fistulae

Steal Syndrome

Infection

Hypotension

Ischaemic heart disease

Question 5

Peritoneal dialysis

What do you use?

Types

Answer 5

1% glucose

Continuous ambulatory (4 hours, 4 times a day)
and Ambulatory (continuously cleaning blood at night)

Question 6

What is the first line RRT

Answer 6

Peritoneal Dialysis (if they are independent)

Question 7

Peritoneal Dilaysis Complications

Answer 7

Failure of peritoneal membrane

Bacterial Peritonitis (E coli, Staph epidermidis [coagulase negative] bc prosthesis)

Sclerosing peritonitis

Question 8

Renal trasplant

Why is it the best RRT?

Answer 8

Replaces endocrine and exocrine funciton

Question 9

Renal transplant

Contraindications

Answer 9

Active vasculitis

Ischaemia (MI)

Stenosis of illiac artery

Active infection

Malignancy

Question 10

Renal Transplant preparation

Answer 10

Test for CMV, hepatitis B, TB

Immunosuppresion: deplete all lymphocytes with amalimubab (anti B

Question 11

Renal transplant

Rejection Types

How to manage

Answer 11

Hyperacute: ABO mismatch (minutes to hours)
- Mx: manage complications (DIC, haemolytics anaemia), immunosuppression

Acute: HLA mismatch and CMV infection [Mx: ganciclovir], additional immunosuppressive therapy

Chronic: HLA mismatch and recurrence of original disease

Question 12

Renal transplant post

Side effects

Answer 12

Steroids + Tacrolimus + Ciclosporin

Tacrolimus: tremor, squamous cell carcinoma, nephrotoxicity, new onset diabetes, hypertension

Ciclosporin: nephrotoxicity, gingival hyperplasia, hypertension, gout

Question 13

Haemofiltration

Answer 13

Used in immediate setting (temporarily taking over function of kidneys)

Via central line

Question 14

Indications of Haemofiltration in AKI

Answer 14

Acidosis pH <7.2 
Electrolyte 
Intoxication: antifreeze, aspirin, 
Oedema pulmonary
Uraemia (pericarditis, encephalopathy)

Question 15

What is the point of AV fistulae?

Answer 15

Arterialise the blood in the vein which is easier to access