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MB2: Renal > transplants and dialysis > Flashcards

transplants and dialysis Flashcards

1
Q

forms of RRT?

A

HD
PD
transplant

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2
Q

types of donation

A

brain stem death
non heart beating
live altruistic donation

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3
Q

when do you see survival benefit post transplant

A

3m

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4
Q

what should you assess pre transplant to make sure patient is fit to undergo?

A 
immunology and blood group
virology 
ECG, ECHO, ETT, CXR, PFT
peripheral vessels
mental state 
comorbidity
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5
Q

contraindication to transplant

A 
malignancy 
active HIV/HCV
untrwated TB
severe IHD 
severe airway disease
vasculitis 
severe PVD 
hostile bladder
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6
Q

live donor transplant assessment

A 
fit?
enough renal function?
anatomically normal?
comorbidity?
immunologically compatible?
psychologically compatiblw?
no coercion?
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7
Q

true/false - O donors can receive from anyone

A

false, they can give to anyone

AB can receive from anyone

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8
Q

what HLA matchingf is looked for in transplant

A

Class I A,B,C

Class II DP, DQ, DR

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9
Q

true/false - HLA mismatch will lead to total organ rejection

A

false - but there is an increased risk graft failure

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10
Q

true/false - those who have had transplants before are at increased risk rejection

A

true - they are sensitised so mismatch of HLA matters more

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11
Q

what are the sensitising events that may lead to graft failure

A

pregnancy
previous transplant
transfusion

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12
Q

what is paired donation

A

when two people need kidneys and there are two seperate donors

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13
Q

how can a person be desensitised prior to transplant

A

plasma exchange

b cell antibody

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14
Q

describe the process of a kidney transplant

A

L/R IF
kidneys left in situ
attached to external iliac artery and vein

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15
Q

complications of kidney transplant

A 
bleeding 
artery stenosis 
venous stenosis 
ureteric stricture 
wound infection 
lymphocele
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16
Q

how can you identify immediate graft function

A

decrease in creatinine

good urine output

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17
Q

what is primary non function

A

transplant never worked

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18
Q

what is delayed graft funtion

A

kidney will work in 10-30 days
need HD in interim
need biopsy to find out why

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19
Q

what is hyperacute rejection and why does it occur

A

never event where preformed ab destroy graft on the table

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20
Q

how is acute rejection managed

A

increased immunosuppression

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21
Q

true/false - chronic rejection can be managed with increased immunosuppression

A

false - function will continue to decline and need new transplant

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22
Q

induction anti rejection immunosuppression

A

Pred IV

basilliximab

23
Q

maintenance anti rejection immunosuppression

A 
pred 
tacrolimus 
MMF 
ciclosporin
azathioprine
24
Q

high dose anti rejection immunosuppression

A 
IV methylprednisolone 
ATG
Ig
plassma exchange 
Rituximab
25
Q

what does CMV infection lead to and how is it treated

A

renal and hepatic dysfunction
oesophagitis, PJP, colitis
prophylactic gancyclovir and IV gancyclovir

26
Q

what does BK nephropathy represent

A

over immunosuppression

27
Q

common cancers for transplant?

A

BCC/SCC

lymphoma

28
Q

causes of graft loss

A 
acute rejection 
death with functioning graft 
recurrent disease 
chronic rejection 
viral nephropathy 
PTLD
29
Q

3 principles of dialyiss

A

diffusion
convection
adsorption

30
Q

describe the basic princiole of dialysis

A

cylinder with hollow filaments had blood passing through it, with ultrapure dialysate in countercurrent to remove toxins

31
Q

describe the use of convection in dialysis

A

machine creates -ve pressure and causes water ultrafiltration, moving electrolytes and uraemic substances with it

32
Q

describe adsorption and what it principally affecs

A

plasma proteins

stick to membrane surface and removed by binding

33
Q

what are the benefits to haemodialyfiltration

A

less symptomatic
better survival and recovery time
similar cost to HD

34
Q

minimum dialysis time

A

4hr 3x weekly

35
Q

fluid restiction on dialysis patients?

A

1L daily if anuric

36
Q

salt restriction on dialysis patients?

A

no more than 2.3g daily

37
Q

phosphate and K restriction on patients

A

low PO4 and K diet

phosphate binders with meals

38
Q

pros and cons of tunnelled central vein catheter

A

pros - immediate and easy to insert

cons - high risk infection, blockage, stenosis and thrombosis of central veins

39
Q

most common organism in central line infection and what can it cause?

A

staph aureus

endocarditis or discitis

40
Q

treatment of central line infection

A

vancomycin and gentamicin

line removsal

41
Q

gold standard vascular access for dialysis?

A

arteriovenous fistula

42
Q

pros and cons of arteriovenous fistula

A

good blood flow and less risk infection

cons - surgery and needs to mature, steal syndrome, thrombosis and stenosis

43
Q

what is a HeRO graft

A

graft attached to brachial artery and into venous outflow component
good for poor central vein thrombosis or stenosis

44
Q

what can go wrong in dialyiss

A 
hypotension 
myocardial stunning 
haemorrhage from ruptured AVF 
arrhythmia 
cardiac arrest
45
Q

describe the process of peritoneal dialysis

A

catheter in peritoneal cavity under umbilicus

sterile dialysate added and in contact with peritoneum to extract uraemic toxins and then exits by ultrafiltration

46
Q

what are the common organisms for peritonitis secondary to PD

A

staph, strep, ecoli, klebsiella and diptheroids

47
Q

complications of PD

A

infection, hernia, peritoneal membrane failure

48
Q

what happens if there is peritoneal membrane failure

A

need to switch to HD

49
Q

when to start dialysis - bloods?

A

resistance hyperkalaemia
unresonsive metabolic acidosis
eGFR <7ml/min
urea>40mmol/L

50
Q

when to start dialysis - symptoms?

A 
nausea 
vomiting 
itch 
fatigue 
fluid overload unresponsive to diuretics 
anorexia
51
Q

who wouldnt you dialyse?

A

patients >75 as they will have similar hospital free days with or without HD

52
Q

medical reasons to discontinue dialysis

A 
haemodynamic instability 
progressive dementia 
agitation 
cardiovascular event 
terminal cancer
53
Q

what is disequilibrium syndrome and what causes it

A

too rapid a correction of uraemic toxins, leading to cerebral oedema, seizure, death, confusion

MB2: Renal (11 decks)

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