RRT Flashcards
What are the indications for renal replacement therapy?
Hyperkalaemia resistant to medical interventions
Metabolic acidosis resistant to medical interventions
Fluid overload resistant to medical interventions
Uraemia complications- pericarditis, encephalopathy (vomiting, confusion)
What are the benefits of peritoneal dialysis?
Doesn’t affect daily activities as much, as it can be done overnight
Can be done at home so reduces need to travel to hosp
Pt can do dialysis themselves, without specialist help
What are the benefits of haemodialysis?
Pt doesnt have to do it themselves
Only have to do it 3 times a week
Filters a lot of blood, quickly
What are the disadvantages of peritoneal dialysis?
Must be done everyday
Limits opportunity for travel
Requires permanent catheter which runs the risk of infection (peritonitis)
Requires a lot of equipment which takes up space at home
What are the disadvantages of haemodialysis?
Filters a lot of bloody quickly so can be dangerous if haemodynamically unstable
Has to be done at a hosp or specialist unit, so requires a lot of travel and time during the day
What is unique to kidney transplants, in relation to compatibility?
A donor kidney MUST be ABO compatible with the recipient, or it will be rejected.
(HLA match is preferred)
What are the different types of kidney transplant?
Live to live
Diseased (non-heart beating or heart beating i.e. on ventilators) to live
Combined (e.g. pancreas and kidney tranplanted at same time in diabetic pt)
What drugs are commonly given following a transplant?
What is the problem with these drugs?
Corticosteroids
Calciurine inhibitors (CNI)- cyclosporin, tacrolimus
Anti metabolites- mycophenolate mofetil, azathioprine
There are lots of drug-drug interaction, and lots of dosage modifications required for certain diseases (e.g. if HIV, CNI are taken once a week instead of BD)
What specific monitoring is done following a kidney transplant?
Measure CNI levels in blood
EGFR, urea and creatinine are used to monitor renal function. If creatinine is persistently high, a kidney biopsy may be done.
What are the possible complications of haemodialysis?
Cardiovascular disease
Fistula complications: stenosis, aneurysm, infection, steal syndrome, heart failure
Hypotension (most common)
Amyloidosis (secondary to build up of B2 microglobulin)
Dialysis disequilibrium syndrome (acute cerebral oedema due to rapid extraction of osmotically active substances)
What are the possible complications of peritoneal dialysis?
Peritoneal dialysis peritonitis
Catheter malfunction
Obesity (due to absorption of glucose from the dialysate fluid)
Hernias.
Describe the presentation and management of peritoneal dialysis peritonitis
This is typically caused by Staphylococcus epidermidis.
The patient presents with abdominal pain, fever, and a cloudy dialysis bag.
The peritoneal dialysis fluid should be sent for culture.
Management is with intraperitoneal and systemic antibiotics.
