Dialysis and Transplantation

Question 1

which toxins can dialysis remove that build up in end stage kidney disease?

Answer 1

urea
potassium
sodium
creatinine

Question 2

which ion can be infused using dialysis?

Answer 2

bicarbonate

Question 3

list the components of dialysate

Answer 3

pure water
sodium
bicarbonate
potassium
glucose

Question 4

how is water removed from the body in dialysis?

Answer 4

create negative pressure across membrane to stuck water out (filtration)

Question 5

true or false: dialysis is very efficient

Answer 5

false

not very efficient, longer treatment improves this

Question 6

what is the time schedule for haemodialysis?

Answer 6

four hours, three times a week

Question 7

how much fluid, salt, potassium and phosphate is allowed during dialysis?

Answer 7

1 litre of water a day
low salt diet
low potassium diet
low phosphate diet

Question 8

what is the gold standard for dialysis access?

Answer 8

arteriovenous fistula, usually in the arm

Question 9

what are the drawbacks of an AV fistula?

Answer 9

requires maturation of 3-6 months before use

can limit blood flow to distal arm

Question 10

what is the alternative access for dialysis whilst the AV fistula is maturing?

Answer 10

tunnelled venous catheter inserted into the jugular, subclavian or femoral vein

Question 11

what are the drawbacks of tunnelled venous catheters?

Answer 11

high risk of infection

damage to the vein

Question 12

what can go wrong with dialysis?

Answer 12

fluid overload/oedema
blood leaks
hypokalaemia, can cause cardiac arrest

Question 13

what is the alternative to haemodialysis and how does it work?

Answer 13

peritoneal dialysis

use peritoneal membrane for diffusion of entering dialysate fluid in the abdomen, which drains into the bag afterwards

Question 14

what is the time schedule for peritoneal dialysis?

Answer 14

four times a day

or

overnight (one bag a day)

Question 15

what is the advantage of peritoneal dialysis over haemodialysis?

Answer 15

portable so less restrictive

Question 16

what are the disadvantages of peritoneal dialysis?

Answer 16

infection
membrane failure
hernias

Question 17

when is dialysis started based on bloods?

Answer 17

resistant hyperkalaemia
GFR less than 5 following preparation
unresponsive acidosis

Question 18

which syndrome can result in the short term following haemodialysis?

Answer 18

disequilibrium syndrome involving cerebral oedema and seizures

Question 19

true or false: in end stage kidney disease, survival with dialysis decreases with increasing age

Answer 19

true

Question 20

true or false: the kidney is taken out in transplant

Answer 20

false

leave the kidneys and put a new kidney in the lower iliac fossa/pelvis

Question 21

which donor blood groups are compatible with recipients with blood group O?

Answer 21

O

Question 22

which donor blood groups are compatible with recipients with blood group A?

Answer 22

O

A

Question 23

which donor blood groups are compatible with recipients with blood group B?

Answer 23

O

B

Question 24

which donor blood groups are compatible with recipients with blood group AB?

Answer 24

O

AB

Question 25

people with blood group O have which antibodies and what does this mean?

Answer 25

anti-A and anti-B antibodies can only receive donor blood from people with blood group O

Question 26

what are HLA proteins?

Answer 26

cell surface proteins that activate the immune system in graft rejection

Question 27

name the main types of HLA proteins

Answer 27

HLA A HLA B HLA DR

Question 28

which HLA are class 1?

Answer 28

HLA A | HLA B

Question 29

which HLA are class 2?

Answer 29

HLA DR

Question 30

true or false: one HLA is inherited from each parent

Answer 30

true

Question 31

what are the main ways HLA antigen exposure can occur?

Answer 31

blood transfusion pregnancy previous transplants

Question 32

name the three forms of graft rejection

Answer 32

hyperacute acute chronic

Question 33

describe hyperacute graft rejection

Answer 33

preformed antibodies to transplant | takes minutes

Question 34

describe acute graft rejection

Answer 34

T or B cell mediated | occurs early on

Question 35

describe chronic graft rejection

Answer 35

immune/vascular deterioration of transplant

Question 36

list some medication that can treat acute graft rejection

Answer 36

steroids MMF cyclosporin tacrolimus

Question 37

which class of drug induces cyclosporin and tacrolimus?

Answer 37

calcineurin inhibitors

Question 38

how do calcineurin inhibitors work?

Answer 38

inhibit activation of CD4 cells

Question 39

list some side effects of calcineurin inhibitors

Answer 39

``` renal dysfunction hypertension diabetes tremors drug interactions ```

Question 40

how do azathioprine and mycophenolate help in immunosuppression?

Answer 40

block purine synthesis - suppress proliferation of B and T cells can cause oversuppression

Question 41

which drug does azathioprine interact dangerously with?

Answer 41

allopurinol

Question 42

list the main types of donor kidney

Answer 42

brain dead patient cardiac dead patient live donor (familial) kidney pancreas dual transplant (diabetics)

Question 43

true or false: allocation of kidneys in the UK is based on tissue typing and then time on the donor list

Answer 43

true

Question 44

list absolute contraindications to transplantation of a kidney

Answer 44

``` malignancy untreated TB severe IHD severe airway disease active vasculitis ```