renal replacement therapies

Question 1

what are indications for dialysis

Answer 1

AEIOU
acidosis 
electrolyte imbalances - hyperkalaemia 
intoxication - overdose 
oedema 
uraemia

Question 2

what is continuous ambulatory peritoneal dialysis

Answer 2

peritoneum membrane is used as a filter
dialysis solution containing dextrose is pumped in to make a gradient and blood gets filtered
waste is removed

Question 3

what are side effects of continuous and overnight ambulatory peritoneal dialysis

Answer 3

weight gain
thickening of membrane/sclerosis
infection
social and psychological effects

Question 4

what is overnight ambulatory peritoneal dialysis

Answer 4

same as ambulatory but done over night

Question 5

what is haemodialysis

Answer 5

machine filters blood
need at least 4hrs a day, 3 days a week
blood is accessed from a fistula or tunnelled cuffed catheter
NEVER TAKE BLOOD FROM A FISTULA - IT IS ONLY FOR DIALYSIS

Question 6

what can you inspect on a fistula site

Answer 6

aneurysms
skin integrity
palpable thrill
machinery murmur on auscultation

Question 7

what are side effects of haemodialysis

Answer 7

steal syndrome if fistula

Question 8

what is an indication for renal transplant

Answer 8

end stage renal disease - GFR less than 15

bicarbonate less than 10mmoles/l

Question 9

how is the new kidney fitted in

Answer 9

in the suprapubic area
old kidneys are not removed
artery and vein are attached to external iliac artery and veins, ureter attached directly to bladder

Question 10

how is rejection avoided

Answer 10

match kidney to patient by HLA types

life long immunosuppression - prednisolone, tacrolimus, mycophenolate

Question 11

what investigations would you do in renal transplant

Answer 11

post op vascular scan to see if new kidney is well perfused

biopsy to look for any signs of rejection like immune cells