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P&T Block 5 Renal > L64 > Flashcards

Flashcards in L64 Deck (33)
1

AEIOU mnemonic for indications for renal replacement therapy

Acidosis (metabolic)
HyperK refractory to treat
Intox - alc + drug intox
Overload - diuretics not working
Uremia

2

What is azotemia vs uremia?

Azo = ↑BUN
Uremia = accum or uremic toxins, how renal failure presents clinically

3

Symptoms of uremia: what does the pt come in complaining about

Metallic taste
N/V
Confusion
Pruritis (itching)

4

Signs of uremia: what do you find on {E

THINK ↑NH4
Asterixis
Myoclonic jerk
Seizures
Pericardial friction rub
Uremic frost: NH4 in sweat, covers skin

5

2 goals of dialysis

Remove 1. solutes (via diffusion) and/or 2. volume (via convection)

6

What is hemodialysis

Get large venous access - run blood through machine with diffusion membranes
Can do @ hospital or home

7

What settings make more efficient dialysis?
1. Membrane type
2. BF rate
3. Duration of dialysis treatment

1. High flux membrane = bigger pores
2. High flow rate = better clearance
3. Longer treatment

8

How is the effectiveness of a dialysis treatment measured?

Det by urea removal

9

Is dialysis solution usually ↑ or ↓ [electrolytes]?

↓ so create a [ ] gradient for excess in blood to flow out

10

What are the 3 access options hemodialysis?

AV fistula: connect AV to ↑size vein due to arterial pressure
AV graft: use basilic vein if veins are bad
Dialysis catheter: under skin into jugular vein

11

Which hemodialysis access option do you prefer?

Fistula - least complications, but takes a while to est

12

Biggest complication of dialysis catheters

Infection -> bactermia -> metastatic infection
1. Coag neg Staph
2. SA
3. GNs

13

Common acute complications of dialysis

↓BP // headache
N/V
Muscle cramps
Chest pain

14

Rare acute complications of dialysis

Allergic rxn to filter
Dialysis disequilibrium syndrome - after 1st treatment, cerebral swelling b/c osmotic shifts after you took out volume too fast

15

Chronic complications of dialysis - which is most likely to cause mortality

Anemia (no EPO from kidney)
Renal osteodystrophy (↓active vit D)
CV disease = #1 cause mortality

16

Explain peritoneal dialysis

Peritoneum = filter
Osmotic agent in fluid = glucose (for fluid removal)
+ ↓ [fluid] - stays in abdomen so some period time
Remove and replace consistently

17

Difference between continuous vs automated peritoneal dialysis

Continuous = long dwell at night
Automated = long dwell during day

18

Pros vs cons peritoneal dialysis

Pros: flexible, might help preserve remaining kidney fxn b/c no drastic vol changes
Cons: fluid 24/7, peritonitis

19

Why dont you want peritoneal dialysis pts to get constipated?

Transbowel bacteria migration
↑risk peritonitis

20

What is continuous renal replacement therapy? Which pts?

Slow, continuous dialysis
For unstable ICU pts - has better hemodynamic stability

21

What is continuous veno-venous hemodialysis?

Hemodialysis but slower

22

What is continuous veno-venous hemofiltration?

Remove excess fluid
Replace with fluid w/ bicarb to dilute BUN/Cr

23

What is continuous veno-venous hemo-diafiltration?

Both hemodialysis + fluid removal/replacement

24

Pros vs cons chronic renal replacement therapy?

Pros: more hemodynamic stability, good clearanceover time
Cons: can't use for intox or hyperK (too slow), not great for electrolyte disorders, freq clotting

25

What is the GFR for kidney transplant eligibility?

GFR

26

Artery and vein the transplant kidney gets hooked up to

R iliac

27

What is cross matching?

To det if recipient has Ab vs donor HLA
Add donor WBC + recipient serum Abs
If positive - stimulate complement = + cross match

28

What is hyperacute rejection?

IMMEDIATE rejection
Less likely b/c do cross match
Not treatable

29

What is acute cellular rejection?

T cell mediated
1st yr

30

Symptoms of acute cellular rejection

USUALLY NOTHING + ↑Cr
Other: fever, enlarged kidney, ↓urine, ↑BP

31

2 infections you're worried about in a kidney transplant pt

CMV - neg recipient got pos donor
BK virus in IC pts (transplant recipients)

32

BK virus causes what 2 things

Tubulo-interstitial nephritis
Ureteral stenosis

33

What is post-transplant lympho-proliferative disorder?

EBV!!!!
B cell proliferation
Extranodal masses: GI, lungs, skin
+ Rituximab