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Y2 Renal > Transplantation > Flashcards

Transplantation Flashcards

1
Q

Dialysis depends on what type of mechanism

A

Diffusion

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2
Q

When is dialysis indicated

A

Acidosis
Electrolyte disturbance - persistent hyperkalaemia
Intoxication
Oedema - persistent pulmonary oedema
Uraemia - pericarditis, encephalopahty

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3
Q

How is vascular access for dialysis established

A

Arteriovenous fistula
Arteriovenous graft
Tunnelled central venous catheter

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4
Q

Most common way of vascular access for dialysis

A

Arteriovenous fistula

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5
Q

What are the problems with arteriovenous fistula

A

Requires surgery
Requires maturation of 6-12 weeks before can be used
Steal syndrome
Blood clots

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6
Q

Why is tunnelled central venous catheter not commonly used

A

High risk of infection

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7
Q

What is the most common pathogen causing infection of tunnelled central venous catheter

A

S aureus

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8
Q

Management of infection of TCVC

A

vancomycin and gentamicin
Line removal or exchange

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9
Q

What are the 3 types of dialysis

A

Haemodialysis
haemofiltration
Peritoneal dialysis

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10
Q

How does haemodialysis remove solutes

A

Mainly Diffusion -> convection -> adsorption (least dependent on)

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11
Q

What is convection

A

movement of molecules through a semipermeable membrane associated with the fluid being removed during ultrafiltration

Independent of solute concentration

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12
Q

What is adsorption

A

affects plasma proteins - stick to the membrane surface and are removed by membrane binding

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13
Q

How does haemofiltration remove solutes

A

Mainly convection -> diffusion -> adsorption

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14
Q

What factors affect convection

A
  • Water flux
  • Membrane pore size
  • Pressure difference (hydrostatic pressure)
  • Viscosity of the fluid
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15
Q

What is peritoneal dialysis

A

Solute removal is by diffusion of solutes across the peritoneal membrane (which is semi-permeable)

Uses the peritoneal membrane as filter

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16
Q

Describe the mechanism of peritoneal dialysis

A
  1. Dialyslate fluid is injected into the peritoneal cavity
  2. When the bag is empty, you disconnect it and place a cap on your catheter so you can move around and do your normal activities
  3. While the dialysis solution is inside your belly, it causes wastes and fluid to be drawn into the peritoneal fluid due to high dextrose concentration of the dialysis solution
  4. then after a few hours, the solution and the wastes are drained out of your belly into the empty bag.
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17
Q

When is peritoneal dialysis used

A

As a stop gap to haemodialysis
For young patients who do not want to go to the hospital all the time

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18
Q

Complications of peritoneal dialysis

A

Peritonitis
Peritoneal membrane failure - unable to filter the wastes out
Hernia

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19
Q

How may peritoneal dialysis cause hernias

A

Due to increase in intra-abdominal pressure

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20
Q

What pathogen commonly causes peritonitis due to peritoneal dialysis

A

Staph epidermidis

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21
Q

Management of peritonitis in patients with peritoneal dialysis

A

vancomycin + ceftazidime added to dialysis fluid
vancomycin added to dialysis fluid + ciprofloxacin by mouth

22
Q

Complications of haemodialysis / haemofiltration

A

Hypotension
Hemorrhage - ruptured arteriovenous fistula
thrombosis
infection
Arrhythmia
Endocarditis

23
Q

How does haemo-dialysis / haemofiltration cause arrhythmia

A

electrolyte imbalance
myocardial ischaemia (due to clots)

24
Q

What lifestyle modifications are patients required to do if they receive dialysis

A

Fluid restriction - 1L a day
Low salt diet
Low potassium diet
Low phosphate diet
Phosphate binders - sevelamer

25
Contraindications of renal transplant
Malignancy Active HCV/HIV infection Untreated TB Severe diseases - airway, vascular
26
What are the aspects of tissue typing for matching a renal transplant
Blood group HLA matching If there are any previous transplants / blood transfusion / pregnancy - this can cause existence of other antibodies
27
What are the HLA groups
Class 1 - A, B and C Class 2 - DP,DQ and DR
28
Which HLA antigen is the most important to be considered when matching HLA groups
DR > B > A
29
Complications of renal transplant
Rejection Thrombosis Bleeding Wound infection Acute Tubular Necrosis of the graft
30
What is acute tubular necrosis of the graft
When the transplant does not start producing urine immediately
31
Rejection of renal transplants can be classified into
Hyperacute rejection Acute rejection Chronic rejection
32
What is considered as hyperacute rejection
Occurring within minutes - hours
33
What causes hyperacute rejection
Due to pre-existing antibodies
34
Which type of hypersensitivity is hyperacute rejection part of
Type II (IgG or IgM mediated)
35
What happens in hyperacute rejection
widespread thrombosis of graft vessels → ischaemia and necrosis of the transplanted organ
36
Is hyperacute rejection salvageable
No, the transplant must be removed
37
What is considered as acute rejection
occurring < 6 months
38
What causes acute rejection
due to mismatched HLA
39
Which type of hypersensitivity is acute rejection part of
Type 4 - it is T cell mediated
40
Acute rejection is usually
asymptomatic
41
Signs of acute rejection
Rising creatinine Pyuria (pus in pee) Proteinuria
42
Is acute rejection salvageable
May be treated with increased immunosuppression
43
What is classified as chronic rejection
occurring after 6 months
44
What is chronic rejection
antibody and cell-mediated mechanisms cause fibrosis to the transplanted kidney -> slow decline in renal function
45
What occurs in chronic rejection
Slow decline in renal function Recurrence of previous renal disease - membranoproliferative GN - IgA GN - focal segmental GS
46
Example regime for immunosuppression for patients with renal transplants
Initial: ciclosporin / tacrolimus + mAB (dacluzimab) maintenance: ciclosporin/tacrolimus + Mycophenolate mofetil (MMF Add steroids if acute rejection episodes
47
tacrolimus can cause
impaired glucose tolerance and diabetes hypertension hyperlipidaemia
48
cyclosporin can cause
impaired glucose tolerance and diabetes hypertension
49
Patients with renal transplant on immunosuppressants should be monitored regularly checking for
Cardiovascular disease - due to tacrolimus and cyclosporin potentially causing hypertension, hyperlipidaemia Renal failure Malignancy - skin cancer
50
Why are patients with renal transplants on immunosuppressants more at risk of skin cancer
Immunosuppression Ciclosporin increases risk of SCC/BCC

Y2 Renal (12 decks)

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