ESRD: Dialysis and Transplant

Question 1

What are the goals of dialysis?

Answer 1

to remove toxins, to maintain euvolemia

Question 2

What are the 2 major types of dialysis?

Answer 2

hemodialysis and peritoneal dialysis

Question 3

When is dialysis necessary?

Answer 3

in severe hyperkalemia, severe volume overload, uremic pericarditis

Question 4

At what GFR is dialysis started?

Answer 4

there is no specific GFR guideline

Question 5

_____ is the most common dialysis modality in the US.

Answer 5

Hemodialysis

Question 6

What is the preferred access for dialysis?

Answer 6

arteriovenous fistula (AVF)

Question 7

How is an AVF created?

Answer 7

surgical anastomosis of an artery to a vein, usually in the arm

Question 8

What are the benefits to AVF dialysis access?

Answer 8

low infection rate

can be used longer than all other forms

Question 9

What are the benefits to arteriovenous grafts (AVGs) dialysis access?

Answer 9

they can be used more quickly

higher 1a success rate

Question 10

What are the benefits to dual lumen catheter dialysis access?

Answer 10

immediate use

Question 11

What are the drawbacks to AVF dialysis access?

Answer 11

they take time to mature (months) and sometimes don’t work

Question 12

What are the drawbacks to arteriovenous grafts (AVGs) dialysis access?

Answer 12

they fail quickly

higher infection risk

Question 13

What are the drawbacks to dual lumen catheter dialysis access?

Answer 13

much higher infection rate

high rate of dysfunction

Question 14

The most common complication of hemodialysis is _____.

Answer 14

bloodstream infection

Question 15

What are the most common bugs causing infection in hemodialysis?

Answer 15

gram + (Staph aureus and coagulase-negative staph)

Question 16

Why is peritoneal dialysis used so frequently outside the US?

Answer 16

it’s cheap and gives the pt autonomy and freedom

Question 17

What are the drawbacks of peritoneal dialysis?

Answer 17

they can cause hernias, infectious peritonitis, catheter problems

Question 18

Patients starting dialysis have a mortality rate greater than ___% for their first year and ____% after 5 years.

Answer 18

20; 50

Question 19

Dialysis pts most commonly die from _____.

Answer 19

CV disease and infections

Question 20

____ is currently the tx of choice for end-stage renal disease.

Answer 20

Kidney transplant

Question 21

The median waiting time for a kidney transplant is ____.

Answer 21

2 years (AB) to 5.5 years (B or O)

Question 22

Which kidney is preferred for donation? Why?

Answer 22

the left b/c it has a longer renal vein

Question 23

The MHC is a group of genes located on the ___ arm of chromosome ____.

Answer 23

short; 6

Question 24

MHC Class ___ is present on all nucleated cells.

Answer 24

I

Question 25

MHC Class I antigens present peptides to ____ cells.

Answer 25

CD8+ cytotoxic T cells

Question 26

MHC Class ____ antigens present peptides to CD8+ cytotoxic T cells.

Answer 26

I

Question 27

MHC Class ___ antigens present extracellular proteins to CD4+ helper T cells.

Answer 27

II

Question 28

MHC Class II antigens present extracellular proteins to _____ cells.

Answer 28

CD4+ helper T

Question 29

What cells carry MHC class II?

Answer 29

dendritic cells, B cells, macs

Question 30

How many HLA matches are taken into account in kidney transplantation?

Answer 30

6

Question 31

The degree of HLA matching affects ___ in kidney transplantation.

Answer 31

long term graft survival

Question 32

What drugs are given to kidney transplant patients to prevent graft rejection?

Answer 32

a calcineurin inhibitor
a proliferation signal inhibitor
prednisone

Question 33

Name 2 calcineurin inhibitors.

Answer 33

cyclosporine and tacrolimus

Question 34

Name 2 classes of proliferation inhibitors.

Answer 34

mycophenolate mofetil, mTOR inhibitors

Question 35

How does mycophenoate mofetil work?

Answer 35

it inhibits purine synthesis