Uro - Dialysis + Liver Transplant Flashcards
What are the 2 main methods of dialysis?
Haemodialysis
Peritoneal dialysis
What is the process of haemodialysis?
Blood from patient enters dialysis machine
Dialysate in the machine is separated from blood by semi-permeable membrane
Waste products and excess nutrients leave blood through semi-permeable membrane and leave machine through “used dialysate” tube
Once blood finished filtering through this process, it enters back into the body.
What is the process of peritoneal dialysis?
Fresh dialysate enters the peritoneal cavity and same process of filtration occurs within the body
After a few hours, used dialysate is pumped out using a catheter.
Where can haemodialysis be done?
Usually requires dialysis centre visits
Can be performed at home
How long does haemodialysis take and how often should it be done?
3 - 4.5 hours of treatment
3 times a week
Allows for 4 treatment free days !
What are the dietary requirements on haemodialysis?
Strict dietary constraints
Strict salt + water intake restrictions
What access is necessary for haemodialysis?
Ideally an arteriovenous fistula
Or a tunnelled central venous line
How do you form an arteriovenous fistula?
Requires an operation under local anaesthetic
What are the risks of a tunnelled central venous line?
Carries risk of bacteraemia if it becomes infected
Where can peritoneal dialysis be performed?
Performed at home, generally overnight
Saves journey + travel times + requirements
How often does peritoneal dialysis need to be done and when?
Normally 7 days a week but often the weekend can be taken off if necessary
Generally done overnight
What are the dietary requirements for peritoneal dialysis?
Lesser constraints for food + water intake
What are the advantages of peritoneal dialysis over haemodialysis?
Less food + water intake restrictions
Can travel very easily - machine packs into wheelie suitcase + fluids delievered by the companies internationally
Day time exchanges can be done anywhere (at work, etc. as you just need to be able to wash your hands(
What are the disadvantages of peritoneal dialysis over haemodialysis?
Chances of infection can be higher due to catheter e.g. can cause peritonitis
What are the factors to consider with live kidney donors?
Age Family history of kidney disease Two healthy kidneys in donor Financial stability (to make sure there is no coercion) Comorbidities Kidney match Future pregnancy Mental health history
What needs to be assessed to ensure live donor has healthy kidneys?
Normal size kidneys (assess on ultrasound)
Normal kidney function (GFR)
No blood, protein in urine
What needs to be checked to ensure a kidney match?
HLA typing
Blood type compatibility
Serum cross match
Where is the transplanted kidney attached in the donor’s body?
Attached in a different anaotmical location to native kidneys
What are the 3 main attachments / stitches made in a kidney transplant?
Donor artery + recipient artery
Donor vein + recipient vein
Donor ureter + recipient bladder
What happened to the native kidneys in a kidney transplantation?
Depends on state of kidneys
Can remain inside the body if healthy enough + don’t damage rest of body
Need to be removed if not
In what scenaroi do the natiev kidneys need ot be removed from the recipient in a kindey transplant?
Polycystic kidneys
Infected kidneys
Cancerous kidneys
What conditions need to be looked out for post kidney transplant?
Cardiovascular disorders
Cancer
Psychiatric disorders
Diabetes
What are the recommendations post-transplant for risk factors of psychiatric disorders?
Being mindful + seeking help
What are the recommendations post-transplant for risk factors of cancer?
Regularly check skin + breasts
Use sunscreen and cover up
What are the recommendations post-transplant for risk factors of CVD and diabetes?
Measure + manage BP
Active lifestyle
Low salt + sugar diet
What are the recommendations on food and water intake post-transplant?
Low salt + sugar diet
Regular fluid intake
Avoid raw eggs, raw meat, undercooked fish, unpasteurised cheese
Avoid foods that interact with tacrolimus (immunosuppressant)
What foods can interact with Tacromilus?
Seville oranges
Marmalade made from Seville O
Earl grey tea
Grapefruit
What should generally be avoided post-transplant?
Liev vaccines Alcohol Smoking Recreational drugs NSAIDs / Herbal medicines
What medications should be kept in check post-surgery?
Immunosuppressive medications
Flu jabs
Antibiotics (check with pharmacist)
