Dialysis & transplantation

Question 1

What is dialysis?

Answer 1

Semipermeable membrane based on diffusion removes toxins from the blood

Question 2

During dialysis which chemicals are being removed?

Answer 2

K+
Urea
Na

Question 3

During dialysis what is added to the blood?

Answer 3

Bicarbonate

Glucose

Question 4

What is the minimum treatment times for dialysis?

Answer 4

4 hours

3 times per week

Question 5

What restrictions does dialysis put on patients?

Answer 5

Fluid (1L per day)
Low salt
Low potassium
Low phosphate

Question 6

Pros of areteriovenous fistula

Answer 6

Good blood flow

Unlikely to cause infection

Question 7

Cons of arteriovenous fistula

Answer 7

Requires surgery
6 weeks to mature
Can limit blood flow to distal arm
Can block

Question 8

Pros of tunneled venous catheter

Answer 8

Easy to insert

Can be used immediately

Question 9

Cons of tunneled venous catheter

Answer 9

High risk of infection

Can cause damage to veins making placing replacements difficult

Question 10

Complications of tunneled venous catheter infection

Answer 10

Endocarditis
Discitis
Death

Question 11

What is the most commonly used antibiotic for tunneled venous catheter

Answer 11

Vancomycin

Question 12

Complications of dialysis

Answer 12

Fluid overload
Blood leaks
Loss of vascular access
Hypokalaemia & cardiac arrest

Question 13

How does peritoneal dialysis work?

Answer 13

Solute removal by diffusion of solutes across the peritoneal membrane
Water removal by osmosis driven by high glucose concentration in dialysafe fluid

Question 14

How many changes a day are needed for CAPD?

Answer 14

4 bag exchanges per day

Question 15

Complications of PD

Answer 15

Infection
Membrane Failure
Hernia’s

Question 16

Investigation for PD infection

Answer 16

Culture PD fluid

Question 17

Treatment of membrane failure in peritoneal dialysis

Answer 17

Switch to haemodialysis (inabiklity to remove enough water so become fluid overload)

Question 18

Why are patients on PD more prone to hernias?

Answer 18

Increased intraabdominal pressure

Question 19

What are the bone metabolic complications of ESKD?

Answer 19

Phosphate retention
Low hydroxylated Vit D
Hypocalcaemia
Raised PTH

Question 20

Metabolic complications in ESKD

Answer 20

Bone mineral metabolism
Anaemia
Sodium & water retention
Accelerated CV disease

Question 21

Biochemical indications to start dialysis

Answer 21

Resistant hyperkalaemia
GFR 45
Unresponsive acidosis

Question 22

What are HLAS?

Answer 22

Cell surface proteins expressed on cells

Question 23

Why is HLA important?

Answer 23

Rejection

Question 24

What causes hyperacute rejection?

Answer 24

Due to +ve X match

Question 25

Treatment of hyperacute rejection

Answer 25

Remove kidney (unsalvagable)

Question 26

What mediates acute rejection?

Answer 26

T cells or B cells

Question 27

Management of acute rejection

Answer 27

Increased immunosupression

Question 28

Examples of calcineurin inhibitors

Answer 28

Cyclosporin | Tacrolimus

Question 29

Mechanism of action of calcineurin inhibitors

Answer 29

Inhibit activation of T helper cells by reducing NK clls activation and reduce cytotoxic T cell activation

Question 30

Side effects of calcineurin inhibitors

Answer 30

Renal dysfunction Hypertension Diabetes Tremors

Question 31

What are azathioprine & mycophenolate?

Answer 31

Antimetabolites by blocking purine synthesis leads to suppression of prolieration of lymphocytes and B cells

Question 32

Side effects of azathioprine & mycophenylate

Answer 32

Leucopaenia Anaemia GI side effects

Question 33

Which drug does azathioprine interact with badly?

Answer 33

Aloopurinol

Question 34

Side effects of steroids

Answer 34

Osteoporosis Weight gain Infection Diabetes

Question 35

What factors make a patient suitable for transplantation?

Answer 35

> 5 year life expectancy within 6 months of HD Tissue typing

Question 36

What is assessed in a patient before transplant?

Answer 36

``` CVS risk Virology CXR Bladder assessment Co-morbidities ```

Question 37

Absolute contraindcationf ro renal transplant

Answer 37

``` Malignancy Untreated TB Severe IHD Severe airways disease Active vasculitis Severe PVD ```

Question 38

Surgical complications of transplant

Answer 38

``` Bleeding Aterial stenosis/thrombosis Venous stenosis/thrombosis Ureteric stricture and hydronephrosis Wound Infection ```

Question 39

Signs of immediate graft function

Answer 39

Urine output good | Falling creatinine & urea

Question 40

Signs of delayed graft function

Answer 40

Post-op acute tubular necrosis

Question 41

Management of delayed graft function

Answer 41

Haemodialysis for 10-30 days till transplant works

Question 42

What happens if a transplant fails?

Answer 42

Patient back on dialysis | Can get another transplant

Question 43

Within what time frame is a rejection considered acute?

Answer 43

6 months

Question 44

What is the most common cause of viral infection in solid organ transplants?

Answer 44

Cytomegalovirus

Question 45

Treatment of cytomegalovirus

Answer 45

Ganciclovir