Renal Replacement Therapy Flashcards
What is the average life expectancy of a patient with end stage renal failure that does not receive RRT?
6 months
What is usually the mean GFR at the start of dialysis?
8-10ml/min
Dialysis is usually provided via what type of venous access?
AV fistula
If dialysis is needed as an immediate treatment there is no time to make an AV fistula. How is venous access established in these cases?
Tunnelled venous catheter
An AV fistula requires how long to mature after surgery before it can be used?
6-12 weeks
The presence of an AV fistula may limit blood flow to the distal arm. What is this complication known as?
Steal syndrome
Tunnelled venous catheters come with a high risk of infection, particularly with which bacteria?
Staph aureus
How often is dialysis needed in order to be an effective treatment?
4 hours of treatment, 3 times per week
The annual mortality of dialysis patients is 20%- this is most commonly due to what?
Cardiovascular disease
Haemodialysis is the most common form of RRT, and works mainly on what scientific principle?
Diffusion
Which solutes are removed from the blood in haemodialysis?
Urea, creatinine, sodium and potassium
Other than water, which solutes are added to the blood in haemodialysis?
Bicarbonate, glucose, sodium and potassium
Too rapid a correction of uraemia (i.e. too much dialysis too soon) leads to what complication? What can this cause?
Disequilibrium syndrome - causes cerebral oedema and seizures
What effect does haemodialysis have on blood pressure?
Decreased (hypotension)
Haemofiltration works mainly on what scientific principle?
Convection
What is the main advantage of haemofiltration over haemodialysis?
Haemofiltration causes less haemodynamic instability
In peritoneal dialysis, the high concentration of what in the dialysis solution draws waste products out of the blood?
Glucose
Which type of peritoneal dialysis involved 4 x 2l bag exchanges throughout the day, while the patient goes around their normal activities?
Continuous ambulatory peritoneal dialysis
Which type of peritoneal dialysis involves a dialysis machine filling and draining the abdomen while the patient sleeps?
Automated peritoneal dialysis
What is the most significant complication of peritoneal dialysis?
Dialysis related peritonitis
Peritoneal membrane failure in peritoneal dialysis may lead to an inability to remove enough water. What complication does this lead to?
Fluid overload
Peritoneal membrane failure in peritoneal dialysis may lead to an inability to remove enough solute. What is the most significant complication that this leads to?
Uraemia
What effect does peritoneal dialysis have on blood glucose levels?
Increased (hyperglycaemia)
Is there an age limit on renal transplants?
No
What are the 3 absolute contraindications to renal transplantation?
Active infection, cancer or severe comorbidity
Which type of renal transplant comes with the highest risk of delayed graft function?
Donor after cardiac death
Which type of renal transplant has the best outcomes?
Living donor transplants
Where is a transplanted kidney inserted into?
Iliac fossa
A transplanted kidney is attached to which vessels?
External iliac artery and vein
After a renal transplant, patients are usually back to full activities in how long?
3 months
Delayed graft function of a renal transplant is usually due to what?
Acute tubular necrosis
In delayed graft function, how long does it usually take for the transplant to start to work?
10-30 days
What is the term for a renal transplant which never starts to work?
Primary non-function
Which type of transplant rejection is more common: humoral or cellular?
Cellular
How is acute transplant rejection treated?
High dose IV methylprednisolone
Acute transplant rejection which is humoral (antibody mediated) often requires what other treatment in addition to intense immunosuppression?
Plasma exchange
Basiliximab is an immunosuppressant medication which is used as induction immunosuppression before renal transplant. This blocks which aspect of the immune system?
IL-2
What immunosuppressant is given during the renal transplant procedure?
IV methylprednisolone
After a renal transplant, most patients are maintained on ‘triple therapy’ immunosuppression. What comprises this therapy?
Calcineurin inhibitor, anti-metabolite and prednisolone
What are two examples of calcineurin inhibitors?
Tacrolimus and ciclosporin
What are two examples of anti-metabolites?
Azathioprine and mycophenolate (MMF)
Calcineurin inhibitors work by inhibiting which aspect of the immune system?
T cells
Calcineurin inhibitors are most likely to cause what type of side effects? Give examples.
Neurological side effects e.g. tremor, confusion
Which immunosuppressant drug causes gum hypertrophy?
Ciclosporin
Anti-metabolites work by inhibiting which aspect of the immune system?
Lymphocytes
What are some potential side effects of anti-metabolite drugs?
Agranulocytosis and hepatitis
Prophylaxis is given against which infection post-renal transplant?
Pneumocystis pneumonia
Infection with what is an important cause of morbidity in the first 3 months of immunosuppression after a renal transplant due to association with early graft loss?
CMV
Which type of cancer is especially common post-renal transplant and should be monitored for with regular reviews?
Non-melanoma skin cancers, especially SSC
Post-renal transplant lymphoproliferative disease is usually related to infection with what?
EBV
