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Renal > RRT > Flashcards

RRT Flashcards

1
Q

When should dialysis be discussed?

A

less than 20ml/min

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2
Q

When are patients referred to vascular surgeons for AVF?

A

15ml/min

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3
Q

When can AVF and peritoneal catheter be used?

A

AVF: 6 weeks

Peritoneal catheter: 1-2 weeks

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4
Q

When can patients be listed for transplant?

A

When within 6 months of dialysis

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5
Q

Dialysis allows removal of what toxins that build up in CKD?

A

Urea
Potassium
Sodium

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6
Q

Dialysis also allows infusion of what?

A

Bicarbonate (if acidotic)

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7
Q

How does dialysis work?

A

Diffusion

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8
Q

How does dialysis get rid of water?

A

Convection (water sucked out across membrane)

Filtration

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9
Q

GFR in dialysis patients

A

10-12

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10
Q

Too quick correction of metabolic issues =

A

Disequilibirum syndrome
Cerebral oedema
Seizures

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11
Q

What restrictions does dialysis put on patient?

A 
Fluid restriction 1L/day
Na restriction 3-4g/day
Glucose restriction
K restriction (low bananas/chocolate/potatoes)
Phosphate restriction (phosphate binders with meals)
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12
Q

Pros of fistula

A

Good blood flow

Unlikely to cause infection

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13
Q

Cons of fistula

A

Surgery
6 weeks to mature
Poor circulation in hand
Can block/thrombose

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14
Q

Tunneled venous catheter

A

Catheter into large vein (jugular/subclavian/femoral/hepatic)

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15
Q

Pros of TVC

A

Easy to insert

Can be used immediately

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16
Q

Cons of TVC

A

High risk of infection
Damage to veins
Block

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17
Q

Treatment of TVC infection

A

Vancomycin

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18
Q

What can go wrong with HD?

A 
Fluid overload
Blood leaks
Loss of vascular access
Hypokalaemia (cardiac arrest)
Intradialytic hypotension (removing large volumes)
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19
Q

Peritoneal dialysis

A

Solute removal by diffusion across peritoneal membrane

Water removal by osmosis driven by high glucose concentration in dialysate fluid

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20
Q

CAPD

A

Continual peritoneal dialysis

4 bag changes per day, 1/2 hour per exchange

21
Q

APD

A

Automated peritoenal dialysis
1 bag stays in all day
Overnight machine drains for 9-10 hours
Can take on holiday

22
Q

What can go wrong with PD?

A

Infection
Membrane failure = switch to HD
Hernia

23
Q

Treatment for PD infection

A

Vancomycin and Gentamicin

24
Q

Metabolic complications in ESKD

A

Bone metabolism (phosphate retention, low Vit D, hypocalcaemia because no Ca reabs, secondary hyperparathyroid = rickets)
Anaemia (epo/iron deificency)
Na and water retention
Accelerated CVD

25
Q

When to start dialysis based on bloods

A

Resistant hyperkalaemia
GFR less than 5
Urea over 45
Unresponsive acidosis

26
Q

When to start dialysis based on symptoms

A 
Fatigue
Itch
N+V
Oedema unresponsive
Loss of appetite
Malnourished
27
Q

Cell surface receptors expressed on cells

A

HLA/MHC

28
Q

3 HLA types important in transplant

A 
HLA-A (class I)
HLA-B (class I)
HLA-DR (class II)
29
Q

How can someone form HLA Abs?

A

Previous exposure to HLA Ag, e.g. blood transfusion, pregnancy, previous transplant

30
Q

Abnormal infections in transplant patients

A 
CMV
BK virus (viral changes in kidney)
Recurrent UTI
Pneumocystis jirovecii = co-trimoxazole
NMSC
Post-transplant lymphoma (EBV)
31
Q

How is rejection diagnosed?

A

Raised CK

Biopsy

32
Q

Hyperacute rejection

A

Minutes
Due to preformed Abs (previous transfusion/transplant)
Vascular thrombosis
Unsalvageable = remove kidney

33
Q

Acute rejection

A

Early
T or B cells
Stop taking pills = acute rejection
Increase immunosuppression

34
Q

Chronic rejection

A

Immunological and vascular deterioration of transplant

35
Q

Periods of immunosuppression

A

Induction
Consolidation
Maintenance

36
Q

How do calcineurin inhibitors work?

A

Inhibit activation of T helper cells = reduce NK activation and cytotoxic T cell activation
Decrease cytokines = no B cells or Abs

37
Q

Example of calcineurin inhibitor

A

Cyclosporin

Tacrolimus

38
Q

Side effects of calcineurin inhibitor

A 
Renal dysfunction
HT
Diabetes
Tremor
Drug interactions (cytochrom p450)
39
Q

How do aza and mycophenolate work?

A

Block purine synthesis = suppresses lymphocytes and B cells

40
Q

Side effects of aza and mycophenolate?

A

Leukopenia (low WCC), anaemia, GI side effects, careful in sun

41
Q

How do steroids work?

A

Non-selectively to suppress T cells and B cells

42
Q

Types of donor kidney

A

DBD
DCD
Live donor
Kidney/Pancreas dual transplant

43
Q

DBD

A

Deceased brain dead - kidneys removed at same time as other organs, removed and put on ice

44
Q

DCD

A

Deceased cardiac death
Only kidney and liver used
Used by local centre

45
Q

Live donor

A

Usually family

Planned, well matched

46
Q

Dual transplant

A

Islet cells and kidney for T1DM

47
Q

Assessing patients for transplant

A 
CV risk (ECG, echo, ETT, cholesterol)
Virology (HBV, HCV, HIV, CMV, EBV)
CXR (tumours)
Bladder assessment
Comorbidity
48
Q

Absolute contraindications for transplant

A 
Malignancy (last 2 years, 5 if breast/colorectal)
Untreated TB/latent TB
Severe IHD
Severe airways disease
Severe PVD
Active vasculitis
49
Q

How long is hospital stay for transplant?

A

7 days

Renal (19 decks)

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