RRT

Question 1

RRT is used when there are issues with

Answer 1

Volume status
BP
Acid-base/electrolyte balance
Serositis/pruritis
Nausea/vomiting/nutritional status deterioration
Cognitive impairment

Question 2

HD frequency

Answer 2

3/week or more (home HD is possible)

Question 3

HD problems

Answer 3

Access (thrombosis/stenosis, infection)
Dialysis dysequilibrium (e.g. between cerebral + blood solutes causing cerebral oedema)
Hypotension
Time consuming

Question 4

Peritoneal dialysis problems

Answer 4

Catheter site infections
PD peritonititis
Hernia
Loss of membrane function over time

Question 5

RRT complications

Answer 5

CVD
Infection (partly due to uraemia causing granulocyte + T-cell dysfunction)

Protein-calorie malnutrition
Renal bone disease
Amyloid deposition (beta2-microglobulin accumulates causing carpal tunnel, arthralgia, visceral effects)

Question 6

Dialysis pt considerations when they present

Answer 6

Check fluid overload + K+, do they need dialysis immediately
Check target weight where they’re euvolaemic
Don’t measure BP on fistula arm
Dose adjust for renal failure (including fluids)
Save veins for dialysis access, get IV access from back of hand

Question 7

Transplant contraindications

Answer 7

Cancer with metastases
Active infection/ HIV with viral replication
Unstable CVD
Congestive heart failure

Question 8

Renal transplant graft types

Answer 8

Living donor (best graft function)
Brain death donor
Expanded criteria donor (with CVA, BP, CKD or older donor)
Donor after cardiac death

Question 9

Immunosuppressants used in transplantation

Answer 9

Monoclonal Abs (daclizumab (CD25 inhibitor), alemtuzumab (T/B-cell depletion)) used at time of transplantation, decrease acute rejection
Calcineurin inhibitors (tacrolimus, ciclosporin) inhibit T cell activation/proliferation, narrow TI
Antimetabolites (MMF, azathioprine) prevents acute rejection + increases graft survival (not in pregnancy)
Glucorticosteroids for acute rejection treatment

Question 10

Transplant complications

Answer 10

Surgical
Delayed graft function (especially in cardiac death donors)
Rejection
Infection (prophylactic CMV + P. jirovecii treatment given)
Malignancy
CVD 3-5x risk than gen pop but 80% less than dialysis
NODAT

Question 11

Transplant prognosis

Answer 11

Acute rejection <15%
1yr graft survival >90%
Longer-term graft loss ~4% per year