Renal Dialysis

Question 1

what is RRT

Answer 1

renal replacement therapy (dialysis or transplant)

Question 2

what is end-stage renal disease

Answer 2

irreversible kidney damage so severely affecting ability to remove waste or adjust blood that they need dialysis or transplant

Question 3

the syndrome of advanced chronic kidney disease

Answer 3

uraemia

Question 4

earliest cardinal symptoms of uraemia

Answer 4

malaise and fatigue

Question 5

what stage of CKD can it remain asymptomatic till

Answer 5

stage 4 or 5

Question 6

what eGFR would indicate RRT

Answer 6

<10ml.min

Question 7

4 types of RRT

Answer 7

transplant, haemodialysis, peritoneal dialysis and conservative kidney management

Question 8

signs of uraemia

Answer 8

hyperpigmentation
pallor
hypertension
postural hypotension
peripheral oedema
LV hypertrophy
PVD
pleural effusion
peripheral neuropathy
restless legs syndrome

Question 9

symptoms of uraemia

Answer 9

anorexia
nausea
vomiting
fatigue
weakness
pruritus
lethargy
dyspnoea
insomnia
cramps
nocturia
polyuria
headace

Question 10

what is CKD

Answer 10

chronic kidney disease –> proteinuria or haematuria and/or reduction in GFR for more than 3 months

Question 11

most common causes of CKD

Answer 11

diabetes and hypertension

Question 12

why is fatigue a symptom of CKD

Answer 12

because anaemia is present from the lack of erythropoietin produced once GFR<50ml/min

Question 13

oedema in CKD is caused by

Answer 13

salt and water retention as GFR declines

Question 14

pruritis, nausea and vomiting in CKD is thought to be caused by

Answer 14

accumulation of toxins

Question 15

what key toxin is not excreted in CKD

Answer 15

urea

Question 16

principle of haemodialysis

Answer 16

blood is pumped through a solute (dialysate) and a semipermeable membrane. The content is filtered by diffusion (solute concentration) and by ultrafiltration (pressure altering water content)

Question 17

what is constantly infused throughout haemodialysis

Answer 17

heparin (anticoagulant)

Question 18

what vascular structure is required for haemodialysis

Answer 18

an arteriovenous fistula

Question 19

4 things needed for dialysis

Answer 19

1. a semipermeable membrane
2. adequate blood exposure to membrane
3. dialysis access
4. anticoagulation (only haemo)

Question 20

what is the semipermeable membrane in peritoneal dialysis

Answer 20

the peritoneum

Question 21

restrictions in dialysis

Answer 21

reduced fluid intake (usually <1L/day) and dietary restriction of potassium sodium and phosphate

Question 22

what is the blood supply in PD

Answer 22

mesentric circulation

Question 23

principle of peritoneal dialysis

Answer 23

a dialysate is instilled through a catheter into the peritoneal cavity. The peritoneum acts as the membrane and after a time the fluid is drain out and replaced with new dialysate

Question 24

3 types of PD

Answer 24

continuous ambulatory, automated or a hybrid

Question 25

what is the most commonly used osmotic agent of PD

Answer 25

glucose

Question 26

which part of dialysis, diffusion or ultrafiltration, is glucose responsible for

Answer 26

ultrafiltration

Question 27

what varies in timing between CAPD and APD

Answer 27

CAPD is throughout the daytime | APD is through night

Question 28

complications of PD

Answer 28

infection of skin or peritoneum | encapsulating peritoneal sclerosis (extensive thickening and fibrosis of peritoneum creating a fibrous cocoon for bowel)

Question 29

if there is PD peritonitis with a gram positive microorganism, where is it's origin

Answer 29

skin

Question 30

if there is PD peritonitis with a gram negative microorganism, where is it's origin

Answer 30

bowel

Question 31

indications for dialysis

Answer 31

GFR 5-10ml/min severe acidosis treatment resistant hyperkalaemia treatment resistant fluid overload

Question 32

which dialysis type is allowed more fluid intake

Answer 32

PD - fluid balance is more continuous

Question 33

main indication for dialysis

Answer 33

symptoms or uraemia or eGFR<10ml/min

Question 34

in haemodialysis urea and creatinine are moved into/removed from the blood

Answer 34

removed from the blood

Question 35

electrolyte movement in dialysis

Answer 35

not neccessarily removed or kept in, more just that they are brought to the right conc in blood