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Renal > RRT > Flashcards

RRT Flashcards

1
Q

What are the three types of dialysis?

A

Haemodialysis (HD)
Haemodiafiltration (HDF)
Peritoneal dialysis (PD)

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2
Q

What does RRT stand for?

A

Renal Replacement Therapy

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3
Q

Why do we need dialysis?

A

To remove toxins that build up because the kidney’s cannot excrete them.

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4
Q

What is the blood flow rate in HD?

A

300-350mls/min

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5
Q

How does dialysis get rid of solutes?

A

Toxins diffuse from high conc in blood to low conc in dialysis fluid

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6
Q

How does dialysis get rid of water?

A

Negative pressure gradient between blood and dialysis fluid forces water out of plasma

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7
Q

What does adsorption affect?

A

Plasma proteins and molecules bound to them

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8
Q

What role does adsorption play in dialysis?

A

Removes small proteins from the blood by binding them to the membrane

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9
Q

How does HDF differ from HD?

A

HD just relied on conc gradient

HDF relies on pressure gradient too

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10
Q

When is HDF used?

A

AKI

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11
Q

What things can affect HFD rate?

A

Water flux (rate and volume)
Membrane pore size (big or little holes, and their respective ratios)
The pressure difference (hydrostatic pressure) applied to and across the membrane
Viscosity of the fluid within the membrane pores
The size, shape and electrical charge of each molecule

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12
Q

What additional thing needs done in HFD?

A

Fluid replacement

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13
Q

What restrictions are caused by dialysis?

A

Fluid, Na, K and P intake

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14
Q

What kinds of venous access are available for dialysis?

A

Scribner Shunt
Tunneled Venous Catheter
Fistula

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15
Q

Describe a Tunneled Venous Catheter

A

Catheter inserted into large vein such as internal jugular

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16
Q

What are some advantages of Tunneled Venous Catheter?

A

Easy access

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17
Q

What are some disadvantages of Tunneled Venous Catheter?

A

High infection risk
Can be blocked easily
Can damage veins and cause thrombosis etc

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18
Q

Describe a fistula for dialysis

A

Link artery to vein to cause Arteriovenous Fistula (AVF)

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19
Q

What are some advantages of a fistula?

A

Good blood flow

Less chance of infection

20
Q

What are some disadvantages of a fistula?

A

Requires surgery
6-12 weeks before it can be used
Limit blood flow to distal arm
Thrombose or stenose

21
Q

What are some potential side effects of dialysis?

A 
Hypotension
Haemorrhage 
Loss of vascular access
Arrhythmia- Electrolyte imbalance
Cardiac arrest
22
Q

How does PD work?

A

Use peritoneum as membrane for diffusion and filtration. Fill with high glucose solution to draw out water.

23
Q

What two forms of PD are available?

A

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Automated Peritoneal Dialysis (APD)

24
Q

How do Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD) differ?

A

CAPD- 4x2L bags per day each taking 30 mins

APD- 1 bag of fluid that’s removed over 10hr at night

25
Q

What are some problems with PD?

A

Infection- Skin or gut
Peritoneal membrane failure- Results in fluid overload and uraemic
Hernias

26
Q

When should dialysis be started?

A

Based on bloods or symptoms

27
Q

What bloods suggest starting dialysis?

A

Resistant hyperkalaemia
eGFR < 7 ml/min
Urea > 40 mmol/L
Unresponsive metabolic acidosis

28
Q

What symptoms suggest starting dialysis?

A 
Nausea
Anorexia
Vomiting
Profound fatigue
Itch
Unresponsive fluid overload
29
Q

How long of a session do you start with HD?

A

60-90mins

30
Q

How long is a standard HD session?

A

4h

31
Q

What can happen if you HD to quickly?

A

Disequilibrium syndrome

32
Q

What are some signs of Disequilibrium syndrome?

A

Cerebral oedema
Confusion
Seizures
Death

33
Q

How long after inserting a PD catheter can you start dialysis?

A

3-6 weeks

34
Q

Why give a patient a renal transplant?

A

Better survival than dialysis
Improves quality of life
Cost effective

35
Q

What are the two sources of organs for transplant?

A

Cadaveric

Live donor

36
Q

What is the main issue with organ transplant?

A

Immune attack by host

37
Q

What is the main barrier to organ transplant?

A

Comorbidities

38
Q

What must you be to receive a renal transplant?

A

Life expectancy >5y

Ability to survive surgery

39
Q

What are some contraindications to transplant?

A 
Untreated malignancy or solid tumour in last 3-5 y
Active HIV or TB
Severe IHD or airway disease
Vasculitis
Hostile bladder
40
Q

What two immunological things must you try to match for a transplant to be successful?

A

Blood and tissue group

41
Q

What are sensitising events?

A

Events that lead to preformed Ab in the blood against nonself

42
Q

Give some examples of sensitising events

A

Blood transfusion
Pregnancy/miscarriage
Previous transplant

43
Q

What is desensitisation?

A

Removal of blood group or donor specific antigens

44
Q

How id desensitisation done?

A

Plasma exchange

B cell antibody (rituximab)

45
Q

What are the types of organ rejection?

A

Hyperacute- Due to preformed antibodies. Unsalvageable
Acute- Due to Ab. Increase immunosuppression
Chronic- Slow decline in function.

46
Q

What is an important complication of immunosuppression?

A

Cytomegalovirus disease

Renal (13 decks)

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