Renal replacement therapy 1 + 2 Flashcards
(39 cards)
• Describe the principles involved in renal replacement therapy and
The principles of surgical and medical management of renal transplantation including selection for renal transplant, medical and surgical complications will be described
Where is the new transplant kidney placed + what are its vessels anastomosed to
Iliac fossa
Vein joined to iliac vein
Artery joined to iliac artery
Ureter joined to bladder
Are the original damaged kidneys removed in renal transplant
No, left in place unless they’re going to interfere with transplant, e.g. if they’re causing repeated UTIs or persistent hypertension despite on drugs
Indications for nephrectomy before a renal transplant (usually the original damaged kidney is just left in place)
Big size - e.g. polycystic kidney disease
If they’re causing chronic urinary infections
Post transplant complications (4)
Bleeding or clotting of the anastomosed vessels
Leaking of ureter at the anastomosed site or blockage
Increased infection risk due to the need to take immunosuppressants to immune system rejecting kidney
Acute rejection
Long term immunosuppressants post transplant increases the risk of what malignancies (2)
skin - most common
lymphoma
Renal placement therapy involves either … or …
dialysis or transplant
List some immunosuppressant subtypes (4) used post-transplant and give an example of each
Corticosteroids - prednisone
Calcineruin inhibitors - tacrolimus, ciclosporin
Anti-proliferative - mycophenolate mofetil
mTOR inhibitors - sirolimus
Side effects of long term corticosteroid use post transplant
Hypertension
Hyperglycaemia
Bone disease
Increased infection risk
General side effects of any immunosuppressant
increased infection risk
Hypertension
GI discomfort
Weight change
The immunosuppression protocol pre and post post transplant consists of 3 groups of medications, what are they
Induction agent - used either before operation or immediately after
Maintenance agents - lifelong
Rejection agents - used specifically in treatment of rejection episodes
Types of transplant donors (3)
Deceased donors
- donation after brain death
- donation after cardiac death
Living donor
Traditional form of deceased organ donor are those that died from
brain death
The number of what form of deceased donor has been on the rise due to its better long term results
donation after cardiac death
How does paired exchange organ donation work
Donor A gives to recipient B, e.g. husband can’t give to their wife but can give to someone else (recipient B)
Donor B gives to recipient A, e.g. recipient B’s sister can’t give to them but can give to recipient A (donor A’s wife)
Kidney transplant is indicated in those with… (2)
End stage kidney disease on dialysis
Advanced CKD - stages 4 or 5
Acute rejection may be suspected if blood level of what isn’t coming down
creatinine
Acute rejection is usually asymptomatic and the attack on the kidneys is either mediated by … or …
T cells (cellular mediated)
Antibody mediated
What endocrine disorder can develop as a side effect to all the immunosuppressants take post transplant
DM
Most significant infection in post kidney transplant patients is
cytomegalovirus (a common virus that remains latent and asymptomatic once infected)
Most significant infection in post kidney transplant patients is cytomegalovirus, the recipient is affected either by … or …
transmission from donor tissue
or
reactivation of latent virus within the recipient
CMV infection post kidney transplant can manifest in 2 ways (one less serious than the other)
Typical viral infection - classic symptoms of fever, myalgia, malaise, fatigue
or
Tissue invasive disease - affecting specific organs
- Principles of dialysis and its main modalities
* state the social, economic and psychological implications of dialysis and renal transplantation.
.
The syndrome of advanced CKD is called uraemia
Uraemic symptoms can involve almost every organ system but the earliest and cardinal symptoms are (2)
malaise + fatigue
