Renal failure Flashcards
(23 cards)
Uraemia, protein loss and Na retention, acidosis, hyperkalaemia, anaemia and vitamin D deficiency
What are you thinking of?
Renal failure
what are some signs and symptoms of uraemia?
pruritus, NV, anorexia, wt loss, lethargy, confusion, restless legs, neuropathy, metallic taste, bleeding
pale, striae, pericardial or pleural rub, fits, coma
what are some signs and symptoms of protein loss and Na retention?
polyuria, polydipsia, oliguria, anuria, SOB
oedema, increased JVP, HTN or hypotension
what are some signs and symptoms of Acidosis?
SOB, confusion
kussmauls respiration
what are some signs and symptoms of hyperkalaemia?
palpitations, chest pain, weakness
Peaked T waves, flattened P waves, increased PR interval, widened QRS, sine-wave pattern leading to VF
what are some signs and symptoms of anaemia?
lethargy, SOB, faintness, tinnitus
pallor, tachycardia, flow murmurs (ESM at apex)
what are some signs and symptoms of Vitamin D deficiency?
bone pain, fractures
osteomalacia–>looser’s zones (pseudo fractures), cupped metaphyses
what is an AV fistula?
a surgically constructed connection between an artery and a vein
what is an AV fistula used for?
it is used in haemodialysis as the main point of catheter access as it allows large amounts of blood to flow during a dialysis treatment.
how does an AV fistula form?
the arterial pressure enlarges/dilates the vein and causes thickened vessel walls able to withstand frequent puncture.
how does haemodialysis work?
a machine is used to pump blood through an artificial filter to enable removal of waste products and fluid. purified blood is then pumped back into the AV fistula into circulation
how does haemodialysis differ from haemofiltration?
haemodialysis involves the movement of solutes by diffusion across a semipermeable membrane whereas haemfiltration involves the movement of solutes by convection across a pressure gradient (positive hydrostatic pressure is used to drive the solutes and water across the membrane)
is haemodialysis or heamofiltration better at removing medium-large molecules from the blood?
haemofiltration
what acts as the semipermeable membrane in peritoneal dialysis?
the peritoneum!
what are some contraindications to peritoneal dialysis?
unsuitable peritoneum due to adhesions, fibrosis or malignancy
why would peritoneal dialysis be used instead of haemodialysis?
it is preferred in patients that want to carry out their normal daily activities. there are fewer restrictions on diet and fluid intake. it puts less strain on the heart
used in infants and young children and inn those who have limited options for vascular access.
what are some post op complications of a renal transplant?
bleeding
graft thrombosis
infection
urinary leaks
what occurs in hyperacute rejection of renal transplant?
occurs after minutes of transplant
ABO incompatibility
thrombosis and SIRS
what occurs in acute rejection of renal transplant?
occurs within 6months
rising creatinine with or without fever and graft pain
cell mediated response
responsive to immunosuppression
what occurs in chronic rejection of renal transplant?
occurs after 6months
interstitial fibrosis and tubular atrophy
gradual increase in creatinine and proteinuria
not responsive to immunosuppression
cyclosporin and tacrolimus can cause nephrotoxicity. what happens in acute nephrotoxicity?
reversible afferent arteriole constriction leading to decreased GFR
cyclosporin and tacrolimus can cause nephrotoxicity. what happens in chronic nephrotoxicity?
tubular atrophy and fibrosis
what are the differentials for rising creatinine in a renal transplant patient?
rejection
obstruction
ATN
drug toxicity
