renal replacment therapy Flashcards
types of renal replacment
Peritoneal Dialysis
Haemodialysis
Transplantation
Peritoneal Dialysis
advan and disad
complic
Advantages
- Quality of life
- excellent first choice for patients starting dialysis
- PD regimes are designed on a much more individualised basis than patients on HD.
Disadvantages
- Patients need to be able to manage technical aspects of dialysis
- Unsuitable in patients with stoma/previous surgery
- Risk of infection (PD peritonitis)
Complications – drainage problems, malposition,
leaks, herniae, hydrothorax, long term use
associated with encapsulating peritoneal sclerosis
hemodialysy
advan and disadvan
Advantages
• Efficient form of dialysis
• Unit-based – plenty of support from staff
Disadvantages/Complications
• Dialysis access needs to be secured
• Infection/Bacteraemia
• Haemodynamic instability
• Reactions to dialysers
sudden drop in bp
• Haematomas/risk of bleeding
• Muscle cramps
• Anaemia due to clotted lines/Haemolysis
- AVF steal syndrome
- SVCO from central lines
renal transplant therapy
Advantages
Near normal lifestyle
Better mortality/morbidity
Disadvantages
• Criteria to meet suitability to safely undergo operation
- Compliance with medication lifelong
- Risk of rejection
- Risk of malignancies over time
- Risk of infection (on immunosuppression) • Long waiting times for cadaveric organ
Contraindications for kidney transplantation
Active infection or malignancy
Severe heart disease not suitable for correction
Severe lung disease
Reversible renal disease
Uncontrolled substance abuse, psychiatric illness
On-going treatment non-adherence
Short life expectancy
types of transplant
- Living Related Donor Transplantation
- Living Unrelated Donor Transplantation
- Deceased Donor Transplantation
Induction & Maintenance treatment
methylprednisolone in combination with any of the following: basiliximab and thymoglobulin; less commonly used are alentuzumab and rituximab.
START (maniatainace)
Steroids: prednisolone (or prednisone)
T-cell regulation: Belatacept and belimumab
Antimetabolite medications: mycophenolate, azathioprine
Rapamycin inhibitors: sirolimus and everolimus
Tacrolimus, cyclosporine, voclosporin
which cancer is more likely to be a complication if renal transplant?
which malignancy is more coomon in thise with EBV infection?
particularly SKIN!!!!!
EBV: post-transplant lymphoproliferative disorder (PTLD),
gynaecological.
Long term care of the transplant patient, what do u monitor and screen for
- Monitor GFR, CNI levels, proteinuria, Ca, phosphate and PTH, lipids and glucose
- Screen for infections (common and opportunistic)
- Vaccination (except live or live attenuated viral vaccines)
- Monitor and control CVS disease, bone and mineral metabolism disease
- Screen for malignancies as patients are three times more likely to have any cancer
- Annual skin checks for skin cancers
- Contraception is obligatory in the first year, counsel about pregnancy one year after
what infection r common in renal transplant pts
Risk of ALL infections.
Typically hospital acquired/donor derived in month 1,
opportunistic in months 1–6 (therefore prophylactic treatment for CMV and Pneu- mocystis jirovecii given),
usual spectrum of community-acquired infection after 6–12 months.
Late viral infection should always be considered: eg CMV, HSV.
Complications of transplantation
Rejection
Infection
Malignancy
new-onset diabetes after transplant (NODAT);
Simultaneous kidney transplantation
Liver-kidney: patients with liver failure or cirrhosis and ESRF can be candidates for simultaneous transplant
Pancreas-kidney: selected patients with Type 1 diabetes mellitus. Can be done simultaneous or sequential
Patients with kidney transplant who progress into ESRF can be re-transplanted
