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Y2 Renal > Transplantation > Flashcards

Transplantation Flashcards

1
Q

Dialysis depends on what type of mechanism

A

Diffusion

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2
Q

When is dialysis indicated

A

Acidosis
Electrolyte disturbance - persistent hyperkalaemia
Intoxication
Oedema - persistent pulmonary oedema
Uraemia - pericarditis, encephalopahty

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3
Q

How is vascular access for dialysis established

A

Arteriovenous fistula
Arteriovenous graft
Tunnelled central venous catheter

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4
Q

Most common way of vascular access for dialysis

A

Arteriovenous fistula

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5
Q

What are the problems with arteriovenous fistula

A

Requires surgery
Requires maturation of 6-12 weeks before can be used
Steal syndrome
Blood clots

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6
Q

Why is tunnelled central venous catheter not commonly used

A

High risk of infection

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7
Q

What is the most common pathogen causing infection of tunnelled central venous catheter

A

S aureus

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8
Q

Management of infection of TCVC

A

vancomycin and gentamicin
Line removal or exchange

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9
Q

What are the 3 types of dialysis

A

Haemodialysis
haemofiltration
Peritoneal dialysis

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10
Q

How does haemodialysis remove solutes

A

Mainly Diffusion -> convection -> adsorption (least dependent on)

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11
Q

What is convection

A

movement of molecules through a semipermeable membrane associated with the fluid being removed during ultrafiltration

Independent of solute concentration

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12
Q

What is adsorption

A

affects plasma proteins - stick to the membrane surface and are removed by membrane binding

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13
Q

How does haemofiltration remove solutes

A

Mainly convection -> diffusion -> adsorption

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14
Q

What factors affect convection

A
  • Water flux
  • Membrane pore size
  • Pressure difference (hydrostatic pressure)
  • Viscosity of the fluid
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15
Q

What is peritoneal dialysis

A

Solute removal is by diffusion of solutes across the peritoneal membrane (which is semi-permeable)

Uses the peritoneal membrane as filter

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16
Q

Describe the mechanism of peritoneal dialysis

A
  1. Dialyslate fluid is injected into the peritoneal cavity
  2. When the bag is empty, you disconnect it and place a cap on your catheter so you can move around and do your normal activities
  3. While the dialysis solution is inside your belly, it causes wastes and fluid to be drawn into the peritoneal fluid due to high dextrose concentration of the dialysis solution
  4. then after a few hours, the solution and the wastes are drained out of your belly into the empty bag.
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17
Q

When is peritoneal dialysis used

A

As a stop gap to haemodialysis
For young patients who do not want to go to the hospital all the time

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18
Q

Complications of peritoneal dialysis

A

Peritonitis
Peritoneal membrane failure - unable to filter the wastes out
Hernia

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19
Q

How may peritoneal dialysis cause hernias

A

Due to increase in intra-abdominal pressure

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20
Q

What pathogen commonly causes peritonitis due to peritoneal dialysis

A

Staph epidermidis

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21
Q

Management of peritonitis in patients with peritoneal dialysis

A

vancomycin + ceftazidime added to dialysis fluid
vancomycin added to dialysis fluid + ciprofloxacin by mouth

22
Q

Complications of haemodialysis / haemofiltration

A

Hypotension
Hemorrhage - ruptured arteriovenous fistula
thrombosis
infection
Arrhythmia
Endocarditis

23
Q

How does haemo-dialysis / haemofiltration cause arrhythmia

A

electrolyte imbalance
myocardial ischaemia (due to clots)

24
Q

What lifestyle modifications are patients required to do if they receive dialysis

A

Fluid restriction - 1L a day
Low salt diet
Low potassium diet
Low phosphate diet
Phosphate binders - sevelamer

25
Q

Contraindications of renal transplant

A

Malignancy
Active HCV/HIV infection
Untreated TB
Severe diseases - airway, vascular

26
Q

What are the aspects of tissue typing for matching a renal transplant

A

Blood group
HLA matching
If there are any previous transplants / blood transfusion / pregnancy
- this can cause existence of other antibodies

27
Q

What are the HLA groups

A

Class 1 - A, B and C
Class 2 - DP,DQ and DR

28
Q

Which HLA antigen is the most important to be considered when matching HLA groups

A

DR > B > A

29
Q

Complications of renal transplant

A

Rejection
Thrombosis
Bleeding
Wound infection
Acute Tubular Necrosis of the graft

30
Q

What is acute tubular necrosis of the graft

A

When the transplant does not start producing urine immediately

31
Q

Rejection of renal transplants can be classified into

A

Hyperacute rejection
Acute rejection
Chronic rejection

32
Q

What is considered as hyperacute rejection

A

Occurring within minutes - hours

33
Q

What causes hyperacute rejection

A

Due to pre-existing antibodies

34
Q

Which type of hypersensitivity is hyperacute rejection part of

A

Type II (IgG or IgM mediated)

35
Q

What happens in hyperacute rejection

A

widespread thrombosis of graft vessels → ischaemia and necrosis of the transplanted organ

36
Q

Is hyperacute rejection salvageable

A

No, the transplant must be removed

37
Q

What is considered as acute rejection

A

occurring < 6 months

38
Q

What causes acute rejection

A

due to mismatched HLA

39
Q

Which type of hypersensitivity is acute rejection part of

A

Type 4 - it is T cell mediated

40
Q

Acute rejection is usually

A

asymptomatic

41
Q

Signs of acute rejection

A

Rising creatinine
Pyuria (pus in pee)
Proteinuria

42
Q

Is acute rejection salvageable

A

May be treated with increased immunosuppression

43
Q

What is classified as chronic rejection

A

occurring after 6 months

44
Q

What is chronic rejection

A

antibody and cell-mediated mechanisms cause fibrosis to the transplanted kidney -> slow decline in renal function

45
Q

What occurs in chronic rejection

A

Slow decline in renal function
Recurrence of previous renal disease
- membranoproliferative GN
- IgA GN
- focal segmental GS

46
Q

Example regime for immunosuppression for patients with renal transplants

A

Initial: ciclosporin / tacrolimus + mAB (dacluzimab)
maintenance: ciclosporin/tacrolimus + Mycophenolate mofetil (MMF

Add steroids if acute rejection episodes

47
Q

tacrolimus can cause

A

impaired glucose tolerance and diabetes
hypertension
hyperlipidaemia

48
Q

cyclosporin can cause

A

impaired glucose tolerance and diabetes
hypertension

49
Q

Patients with renal transplant on immunosuppressants should be monitored regularly checking for

A

Cardiovascular disease - due to tacrolimus and cyclosporin potentially causing hypertension, hyperlipidaemia
Renal failure
Malignancy - skin cancer

50
Q

Why are patients with renal transplants on immunosuppressants more at risk of skin cancer

A

Immunosuppression
Ciclosporin increases risk of SCC/BCC

Y2 Renal (12 decks)

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