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Gen Med (Renal) > Renal Replacement Therapy > Flashcards

Renal Replacement Therapy Flashcards

1
Q

What is the average life expectancy of a patient with end stage renal failure that does not receive RRT?

A

6 months

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2
Q

What is usually the mean GFR at the start of dialysis?

A

8-10ml/min

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3
Q

Dialysis is usually provided via what type of venous access?

A

AV fistula

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4
Q

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?

A

Tunnelled venous catheter

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5
Q

An AV fistula requires how long to mature after surgery before it can be used?

A

6-12 weeks

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6
Q

The presence of an AV fistula may limit blood flow to the distal arm. What is this complication known as?

A

Steal syndrome

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7
Q

Tunnelled venous catheters come with a high risk of infection, particularly with which bacteria?

A

Staph aureus

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8
Q

How often is dialysis needed in order to be an effective treatment?

A

4 hours of treatment, 3 times per week

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9
Q

The annual mortality of dialysis patients is 20%- this is most commonly due to what?

A

Cardiovascular disease

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10
Q

Haemodialysis is the most common form of RRT, and works mainly on what scientific principle?

A

Diffusion

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11
Q

Which solutes are removed from the blood in haemodialysis?

A

Urea, creatinine, sodium and potassium

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12
Q

Other than water, which solutes are added to the blood in haemodialysis?

A

Bicarbonate, glucose, sodium and potassium

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13
Q

Too rapid a correction of uraemia (i.e. too much dialysis too soon) leads to what complication? What can this cause?

A

Disequilibrium syndrome - causes cerebral oedema and seizures

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14
Q

What effect does haemodialysis have on blood pressure?

A

Decreased (hypotension)

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15
Q

Haemofiltration works mainly on what scientific principle?

A

Convection

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16
Q

What is the main advantage of haemofiltration over haemodialysis?

A

Haemofiltration causes less haemodynamic instability

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17
Q

In peritoneal dialysis, the high concentration of what in the dialysis solution draws waste products out of the blood?

A

Glucose

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18
Q

Which type of peritoneal dialysis involved 4 x 2l bag exchanges throughout the day, while the patient goes around their normal activities?

A

Continuous ambulatory peritoneal dialysis

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19
Q

Which type of peritoneal dialysis involves a dialysis machine filling and draining the abdomen while the patient sleeps?

A

Automated peritoneal dialysis

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20
Q

What is the most significant complication of peritoneal dialysis?

A

Dialysis related peritonitis

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21
Q

Peritoneal membrane failure in peritoneal dialysis may lead to an inability to remove enough water. What complication does this lead to?

A

Fluid overload

22
Q

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?

A

Uraemia

23
Q

What effect does peritoneal dialysis have on blood glucose levels?

A

Increased (hyperglycaemia)

24
Q

Is there an age limit on renal transplants?

A

No

25
Q

What are the 3 absolute contraindications to renal transplantation?

A

Active infection, cancer or severe comorbidity

26
Q

Which type of renal transplant comes with the highest risk of delayed graft function?

A

Donor after cardiac death

27
Q

Which type of renal transplant has the best outcomes?

A

Living donor transplants

28
Q

Where is a transplanted kidney inserted into?

A

Iliac fossa

29
Q

A transplanted kidney is attached to which vessels?

A

External iliac artery and vein

30
Q

After a renal transplant, patients are usually back to full activities in how long?

A

3 months

31
Q

Delayed graft function of a renal transplant is usually due to what?

A

Acute tubular necrosis

32
Q

In delayed graft function, how long does it usually take for the transplant to start to work?

A

10-30 days

33
Q

What is the term for a renal transplant which never starts to work?

A

Primary non-function

34
Q

Which type of transplant rejection is more common: humoral or cellular?

A

Cellular

35
Q

How is acute transplant rejection treated?

A

High dose IV methylprednisolone

36
Q

Acute transplant rejection which is humoral (antibody mediated) often requires what other treatment in addition to intense immunosuppression?

A

Plasma exchange

37
Q

Basiliximab is an immunosuppressant medication which is used as induction immunosuppression before renal transplant. This blocks which aspect of the immune system?

A

IL-2

38
Q

What immunosuppressant is given during the renal transplant procedure?

A

IV methylprednisolone

39
Q

After a renal transplant, most patients are maintained on ‘triple therapy’ immunosuppression. What comprises this therapy?

A

Calcineurin inhibitor, anti-metabolite and prednisolone

40
Q

What are two examples of calcineurin inhibitors?

A

Tacrolimus and ciclosporin

41
Q

What are two examples of anti-metabolites?

A

Azathioprine and mycophenolate (MMF)

42
Q

Calcineurin inhibitors work by inhibiting which aspect of the immune system?

A

T cells

43
Q

Calcineurin inhibitors are most likely to cause what type of side effects? Give examples.

A

Neurological side effects e.g. tremor, confusion

44
Q

Which immunosuppressant drug causes gum hypertrophy?

A

Ciclosporin

45
Q

Anti-metabolites work by inhibiting which aspect of the immune system?

A

Lymphocytes

46
Q

What are some potential side effects of anti-metabolite drugs?

A

Agranulocytosis and hepatitis

47
Q

Prophylaxis is given against which infection post-renal transplant?

A

Pneumocystis pneumonia

48
Q

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?

A

CMV

49
Q

Which type of cancer is especially common post-renal transplant and should be monitored for with regular reviews?

A

Non-melanoma skin cancers, especially SSC

50
Q

Post-renal transplant lymphoproliferative disease is usually related to infection with what?

A

EBV

Gen Med (Renal) (18 decks)

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