W2L2 RRT

Question 1

Definition?

Answer 1

Therapy that replaces normal blood filtering function of kidneys

Question 2

MODALITIES OF RRT?

Answer 2

1) HEMODIALYSIS
2) PERITONEAL DIALYSIS
3) RENAL TRANSPLANTATION

Question 3

Dialysis depends on?

Answer 3

a) Age & size of patient
b) Cardiovascular status
c) Availability of vascular status
d) Integrity peritoneal membrane & abd cavity
e) Expertise available

Question 4

Indication dialysis in AKI?

Answer 4

1) Uremia
2) Hyperkalemia
3) Hypermagnesemia
4) Fluid overload
5) Metabolic Acidosis
6) Hypercatabolic state
7) Dialyazable toxin injestion(Methanol)

Question 5

Indication dialysis in CKD?

Answer 5

1) GFR <15ml/min/1.73m² BSA
2) Growth Failure
3) Severe HTN
4) Intractable intravascular volume overload
5) Profound electrolyte abnormalities
6) Uremia

Question 6

Types of PD?

Answer 6

Manual(CAPD)

Automated(CCPD, NIPD, TDP)

Question 7

Complications of PD?

Answer 7

1) Bleeding after catheter insertion
2) Perforation of gut.
3) Abdominal pain
4) Leakage around catheter
5) Difficult Drainage
6) Exit site infections.
7) Peritonitis
8) Metabolic problems(metabolic alkalosis)

Question 8

Complicaions during Hemodialysis?

Answer 8

1. Dialysis disequilibrium syndrome: Manifested as seizures
2. Muscle Cramps
3. Hypotension.
4. Nausea & Vomiting
5. Itching

Question 9

Disadvantages of HD?

Answer 9

1. Hemodynamic instability
2. Hypoxemia
3. Rapid fluid + solute shifts
4. Complex equipment
5. Specialized personnel
6. Difficult in small infants

Question 10

Indication for CRRT?

Answer 10

1. Critically ill & hemodynamically unstable pt
2. Neonates & infants with cardiovascular/ abd surgery
3. Trauma
4. Shock & multi-system failure.
5. Children with inborn errors of metabolism (urea cycle disorders)

Question 11

Disadvantages of CRRT?

Answer 11

1. Same as Hemodialysis
2. Continous nature risk (greatly multiplied)
3. Continuous vascular access, very close monitoring
   - very expensive
   - Hypophsphatemia
   - Large doses of Anticoagulation

Question 12

Where renal transplant?

Answer 12

Illiac fossa & retroperitoneally

Question 13

Types of donor?

Answer 13

• living donor

- deceased donor

Question 14

Indication of renal transplant?

Answer 14

1. ESRD GFR <15ml
2. Malignancy
3. HTN
4. DM
5. Genetic disease
6. Metabolic disorder
7. Autoimmune disease
8. CRF

Question 15

Recipient Contraindications?

Answer 15

Absolute contra

• active GN
• active bacterial
• active malignancy

Relative contra

• severe psychiatric
• hepatitis c
• primary renal disease

Question 16

Living donor contra?

Answer 16

Absolute contra

• <18y
• uncontrol HTN
• DM
• abnormal GFR
• HIV +ve

Relative contra

• active chronic inf
• obese
• psychiatric disorder