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FINALS RENAL + UROLOGY > dialysis > Flashcards

dialysis Flashcards

1
Q

indications for starting emergency dialysis

A

hyperkalaemia // eGFR <7 // urea >40 // unresponsive met acidosis

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2
Q

what is eGFR renal failure

A

<15

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3
Q

symptoms renal failure

A

SOB, fatigue, itch, can’t eat, N+V, muscle cramp, anxiety + depression,

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4
Q

frequency of haemodialysis

A

3/wk for 3-5 hours each

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5
Q

what is removed and replaced in haemodialysis

A

out = urea, K, Na // in = water, HCO3, glucose

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6
Q

dietary restrictions dialysis

A

1L fluid // low salt // low K // low phosphate

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7
Q

gold standard access for dialysis

A

AV fistula

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8
Q

how long do fistulas take to develop

A

6-8 weeks

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9
Q

sites for AV fistula

A

Radio-cephalic / Brachiocephalic / Brachio-basilic

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10
Q

SE AV fistulas (4)

A

infection, thrombosis, stenosis, steal syndrome

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11
Q

what is a tunnelled venous catheter

A

catheter –> large vein eg internal jugular (not preferred anymore)

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12
Q

what drives waste exchange in PD

A

dextrose in dialysis solution

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13
Q

what is Continuous ambulatory peritoneal dialysis (CAPD)

A

exchange lasts 30-40 minutes then dialysis solution inserted into abdomen for 4-8 hours // patient can go about day with solution in abdomen // 4x2L per day

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14
Q

what is automated peritoneal dialysis (APD)

A

dialysis machine fills and drains abdomen whilst patient is sleeping // 3-5 exchanges over 8-10 hours

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15
Q

when is PD preferred

A

when patients do not want to enter hospital 3x a week

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16
Q

commonest complication PD

A

peritonitis

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17
Q

orgnaism peritonitis

A

1 = staph epi // 2 = staph A // sometimes gram-ives from gut

18
Q

mx peritonitis

A

vanco + ceftazidime into PD // OR vanco into PD + cipro oral

19
Q

what antigens are present on type O blood

A

none

20
Q

who can type O blood donate + recieve

A

donate to everyone // receive only

21
Q

who can type O blood donate + recieve

A

donate to everyone // receive only O

22
Q

who can type AB donate + recieve from

A

receive everyone only donate to AB

23
Q

what are the 4 most important HLA alleles + which are most important to match

A

DR most –> B –> A (–> C least)

24
Q

what happens if the body encounters and HLA allele not found within the body

A

sensitising event –> activate T cells –> auto-antibodies

25
Q

what chromosome is HLA on

A

6

26
Q

what is an allogrant transplant

A

non-identical same species eg non-related organ donor

27
Q

what is isograft transplant

A

donation of identical organ eg identical twins

28
Q

what is autograft transplant

A

from one tissue of a person eg skin graft

29
Q

what is xenograft transplant

A

from another species eg porcine heart valve

30
Q

post-op problems kidney transplant

A

acute tubular necrosis // thrombosis // urine leak // UTI

31
Q

what causes hyper-acute rejection

A

antibodies to ABO or HLA (type II hypersensitivity)

32
Q

symptoms of hyperacute rejection + mx

A

thrombosis of graft –> ischaemia of organ // takes minutes to hours // remove graft

33
Q

what causes acute graft failure

A

HLA mediated (T cells) // CMV infection

34
Q

symptoms acute graft failure

A

< 6months months // rising creatinine, pyuria, proteinuria

35
Q

diagnosis CMV

A

PCR IgG

36
Q

mx acute graft failure

A

steroids + immunosuppression

37
Q

mx CMV

A

Prophylactic valganciclovir // IV ganciclovir

38
Q

causes chronic graft failure

A

antibody + cell mediated –> fibrosis (over 6+ months)

39
Q

exclusion criteria renal transplant

A

cancer + old ge

40
Q

what initial immunosuppression is used in renal transplant

A

ciclosporin/ tacrolimus + monoclonal antibody

41
Q

maintenance immunosuppression renal transplant

A

ciclosporin/ tacrolimus + MMF or sirlomus // + steroid in acute rejection

FINALS RENAL + UROLOGY (16 decks)

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