Urinary: Renal Support Flashcards
What is the definition of end stage renal failure?
When death is likely without renal replacement therapy
eGFR <15ml/min
What are the psychological symptoms of end stage renal disease?
Tiredness: overwhelming fatigue, physically and mentally exhausted, feel guilty for needing to rest
Difficulty sleeping and concentration
?symptoms dont differ much from depression
What are the physical symptoms of end stage renal disease?
- volume overload eg oedema
- nausea and vomiting
- restless legs
- pruritus (intense itching)
- sexual dysfunction
- increased infections
How does chronic kidney disease affect water and salt handling by the kidney?
There is reduced GFR so lose the ability to maximally dilute and concentrate urine
What symptoms does accumulation of waste products cause?
Reduced appetitie - particularly meat which may be a protective mechanism to prevent nitrogenous waste products
Nausea and vomiting
Contributes to pruritus
Why do you need to alter drug doses in someone with CKD/ESRD?
There is reduced metabolisms and/or elimination
Drug sensitivity can be increased making side effects more likely eg statins
What is the endocrine function of the kidney?
Synthesises renin for the RAAS system
Vitamin D metabolism
Synthesis erythropoietin needed for RBC production
What are the pros and cons of unit-based haemodialysis?
4hrs 3x per week
Advantages: less responsibility, have days off
Disadvantages: travel time, have a set slot which need to stick to, big restriction on fluid and food intake
Who is not suitable for haemodialysis?
- if there is no vascular access
- if they have bad heart failure (have to take 300ml blood out at a time)
- if they have coagulopathy (a vein has to be attached to artery so is high pressure and can bleed lots)
What are some potential complications of haemodialysis?
Lines - infection, thrombosis, scarring
CVS instability
Feel chronically unwell
What are the 2 types of peritoneal dialysis?
CAPD: 4-5 bags throughout the day
APD: overnight dialysis, connect to a machine
What are the pros and cons of peritoneal dialysis?
Advantages: more independence, less food and fluid restrictions, can travel, better renal preservation initially
Disadvantages: there needs to be frequent 30 min exchanges, you have responsibility for your own care
Who is not suitable for peritoneal dialysis?
- if they are obese or have large muscle mass, poor peritoneal area to whole body ratio
- failure of peritoneal membrane eg too much scarring from previous surgery
- hernias, stomas
What are some potential complications of peritoneal dialysis?
- peritonitis (average of 1 episode every 20 months)
- tunnel site infections
- leaks
- development of herniae
What are the pros and cons of renal transplant?
Advantages: reduced mortality and morbidity compared to dialysis, better quality of life
Disadvantages: operative risk, malignancy risk, infection, have to take immunosuppressants
What are the different types of transplant?
Live donor
Deceased after brain death - so organs still perfused
Deceased after circulatory death - so organs not perfused
How long does a transplant last?
around 11 years
What is conservative life care?
For those who dont want to have dialysis eg the elderly
