Week 5 (1) Flashcards
What toxins build up in ESKD?
- Urea
- Potassium
- Sodium
What does dialysis allow the infusion of?
Bicarbonate
What restrictions are on a patient with dialysis?
- Fluid - 1 litre a day
- Salt
- Potassium
- Phospahte
What does a fistula join?
An artery and a vein
What does peritoneal dialysis use the peritoneum as?
The artificial membrane
What is the water removal by osmosis driven by in periotneal dyalisis?
High glucose concentration in dialysate fluid
What are 4 bone mineral metabolism complications in ESKD?
- Phosphaste retention
- Low 1-25 vitamin D
- Hypocalcaemia
- Raised PTH
What risk increases with ESKD?
Cardiovascular
What four conditions require immediate start of dialysis?
- Resistant hyperkalaemia
- GFR less than 5
- Urea more than 45
- Unresponsive acidosis
What are the three important HLA molecules in transplant?
- HLA A
- HLA B
- HLA DR
When does hyperacute rejection occur?
Within minutes - due to preformed antibodies to the transplant
What immunosuppression is required for induction of transplant?
Steroids, MMF, CyA, tacrolimus, antibodies
What drug class act by inhibiting activation of T helper cells?
Cyclosporin and tacrolimus - calcineurin inhibitors
How are calcineurin inhibitors metabolised?
By cytochrome p450
What are renal dysfunction, hypertension, diabetes and tremors side effects of?
Calcineurin inhibitors
What drugs are antimetabolites by blocking purine synthesis?
Azthioprine
What are side effects of azathioprine?
Leucopaenia, anaemia, GI
What shoudl azathioprine not be usedc with?
Allopurinol
What is charaxcyerised by persistent albuminuria over 300 on at least 2 occassions 3 months apart?
overt diabetic nephropathy
What are 3 changes in diabetic nephropathy?
- Afferent arteriolar vasodilataion mediated by IGF-1
- Hyperfiltration
- increased GFR
During the pathogenesis of diabetic nephropathy - what happens to the mesangial?
It expands as a result of renal hypertrophy
What is Kimmelsteil-Wilson lesions?
Nodular diabetic glomerulosclerosis
In pathogeneiss of diabetic nephroapahty - what causes proteinuria?
GBM thickening and podocyte dysfunction
In diabetic nephropathy how are lipid levels controlled?
With a statin