Week 11 - Renal replacement service

Question 1

What are the 5 major functions of the kidney?

Answer 1

• BP
• Blood volume
• Electrolytes
• pH
• Osmalarity

Question 2

Why is endocrine function of the kidney more clinically important in CKD then AKI?

Answer 2

-Endocrine system takes longer to damage so effects become present over a longer period of time

Question 3

What are the major endocrine functions of the kidney?

Answer 3

• RAAS
• Erythropoetin
• Vit D metabolism

Question 4

Describe some of the major symptoms of end stage renal failure

Answer 4

• Tiredness
• Uraemic symptoms
• Symtpoms of volume overload
• Pruritis
• Restless legs/cramps

Question 5

Why are people with end-stage renal failure often hypertensive?

Answer 5

-Cannot regulate Na and H2O effectively and loose the ability to regulate blood volume

Question 6

Why do drug doses need to be altered in people with end stage renal failure?

Answer 6

-Decreased kidney function decreases metabolism and elimination of drugs

Question 7

What are the 4 possible options of treatment when end stage renal failure is reached?

Answer 7

• Haemodialysis
• Peritoneal dialysis
• Conservative care
• Transplant

Question 8

Explain haemodialysis

Answer 8

• Arteriovenous fistula is made and blood is drained and passed through the dialyzer
• The dialyzer fluid flows in opposite direction to the blood and removes waste product and alters electrolyte balance of the blood
• The blood is pumped back into the body

Question 9

How many times a week is haemodilaysis?

Answer 9

-Designated slot for 4 hours 3x a week

Question 10

What are the advantages of haemodialysis?

Answer 10

• Less responsibility

- Days off

Question 11

What are the disadvantages of haemodialysis?

Answer 11

• Traveling time/waiting time
• unflexibility of dialysis times
• Big restriction of fluid/food intake
• Large number of oral meds

Question 12

What are the contraindications for haemodialysis?

Answer 12

• Failed vascular access
• Heart failure (cannot cope with reduced preload)
• Coagulopathy

Question 13

What complications often arise from haemodialysis?

Answer 13

• Infection of lines
• CVS instability
• Chronically unwell

Question 14

Explain peritoneal dialysis

Answer 14

• Uses the peritoneum as the dialyser membrane
• Dialysate solution drained into the abdomen, exchange of electrolytes and waste products occurs and then used dialysate drained from the abdomen about 4-5 times per day or over night

Question 15

What are the advantages of peritoneal dialysis?

Answer 15

• Self-sufficient/independence
• Less fluid/food restriction
• Less oral tablets daily

Question 16

What are the disadvantages of peritoneal dialysis?

Answer 16

• Responsibility

- frequent daily exchanges every day

Question 17

What are some contraindications for peritoneal dialysis?

Answer 17

• Failure of peritoneal membrane
• Adhesions from previous surgery
• Inability to connect and disconnect bags
• Obese/large muscle mass

Question 18

Name some complications of peritoneal dialysis

Answer 18

• Peritonitis
• Ultrafiltration failure
• Leaks

Question 19

What is the best treatment option in terms of mortality for end-stage renal failure?

Answer 19

-Transplant

Question 20

Where is the transplanted kidney placed?

Answer 20

-Right iliac fossa

Question 21

What types of transplant are possible?

Answer 21

• Live donor
• Deceased after brain death
• Decreased after circulatory death

Question 22

How does the transplant list work?

Answer 22

-Tissue match and the number of points a patient has (age, waiting time etc)

Question 23

How long on average does a transplant last?

Answer 23

-11 years

Question 24

What is the most common cause of death for dialysis patients?

Answer 24

-Cardiovascular

Question 25

What is the most common cause of death for transplant patients?

Answer 25

-Malignancy

Question 26

Define end-stage renal failure

Answer 26

-When death is likely without renal replacement therapy