Uro - Dialysis + Liver Transplant

Question 1

What are the 2 main methods of dialysis?

Answer 1

Haemodialysis

Peritoneal dialysis

Question 2

What is the process of haemodialysis?

Answer 2

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.

Question 3

What is the process of peritoneal dialysis?

Answer 3

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.

Question 4

Where can haemodialysis be done?

Answer 4

Usually requires dialysis centre visits

Can be performed at home

Question 5

How long does haemodialysis take and how often should it be done?

Answer 5

3 - 4.5 hours of treatment
3 times a week
Allows for 4 treatment free days !

Question 6

What are the dietary requirements on haemodialysis?

Answer 6

Strict dietary constraints

Strict salt + water intake restrictions

Question 7

What access is necessary for haemodialysis?

Answer 7

Ideally an arteriovenous fistula

Or a tunnelled central venous line

Question 8

How do you form an arteriovenous fistula?

Answer 8

Requires an operation under local anaesthetic

Question 9

What are the risks of a tunnelled central venous line?

Answer 9

Carries risk of bacteraemia if it becomes infected

Question 10

Where can peritoneal dialysis be performed?

Answer 10

Performed at home, generally overnight

Saves journey + travel times + requirements

Question 11

How often does peritoneal dialysis need to be done and when?

Answer 11

Normally 7 days a week but often the weekend can be taken off if necessary
Generally done overnight

Question 12

What are the dietary requirements for peritoneal dialysis?

Answer 12

Lesser constraints for food + water intake

Question 13

What are the advantages of peritoneal dialysis over haemodialysis?

Answer 13

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(

Question 14

What are the disadvantages of peritoneal dialysis over haemodialysis?

Answer 14

Chances of infection can be higher due to catheter e.g. can cause peritonitis

Question 15

What are the factors to consider with live kidney donors?

Answer 15

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

Question 16

What needs to be assessed to ensure live donor has healthy kidneys?

Answer 16

Normal size kidneys (assess on ultrasound)
Normal kidney function (GFR)
No blood, protein in urine

Question 17

What needs to be checked to ensure a kidney match?

Answer 17

HLA typing
Blood type compatibility
Serum cross match

Question 18

Where is the transplanted kidney attached in the donor’s body?

Answer 18

Attached in a different anaotmical location to native kidneys

Question 19

What are the 3 main attachments / stitches made in a kidney transplant?

Answer 19

Donor artery + recipient artery
Donor vein + recipient vein
Donor ureter + recipient bladder

Question 20

What happened to the native kidneys in a kidney transplantation?

Answer 20

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

Question 21

In what scenaroi do the natiev kidneys need ot be removed from the recipient in a kindey transplant?

Answer 21

Polycystic kidneys
Infected kidneys
Cancerous kidneys

Question 22

What conditions need to be looked out for post kidney transplant?

Answer 22

Cardiovascular disorders
Cancer
Psychiatric disorders
Diabetes

Question 23

What are the recommendations post-transplant for risk factors of psychiatric disorders?

Answer 23

Being mindful + seeking help

Question 24

What are the recommendations post-transplant for risk factors of cancer?

Answer 24

Regularly check skin + breasts

Use sunscreen and cover up

Question 25

What are the recommendations post-transplant for risk factors of CVD and diabetes?

Answer 25

Measure + manage BP
Active lifestyle
Low salt + sugar diet

Question 26

What are the recommendations on food and water intake post-transplant?

Answer 26

Low salt + sugar diet
Regular fluid intake
Avoid raw eggs, raw meat, undercooked fish, unpasteurised cheese
Avoid foods that interact with tacrolimus (immunosuppressant)

Question 27

What foods can interact with Tacromilus?

Answer 27

Seville oranges
Marmalade made from Seville O
Earl grey tea
Grapefruit

Question 28

What should generally be avoided post-transplant?

Answer 28

Liev vaccines
Alcohol
Smoking
Recreational drugs
NSAIDs / Herbal medicines

Question 29

What medications should be kept in check post-surgery?

Answer 29

Immunosuppressive medications
Flu jabs
Antibiotics (check with pharmacist)