Renal Replacement Therapy

Question 1

Which organ activates Vitamin D

Answer 1

Kidneys

Question 2

Which organ produces erythropoietin

Answer 2

Kidneys

Question 3

Until which stage of CKD may patient be asymptomatic

Answer 3

CKD Stage 4 or 5

Question 4

What is advanced CKD called

Answer 4

Uraemia

Question 5

Earliest Symptom of Uraemia

Answer 5

Malaise and Fatigue

Question 6

When is Renal Replacement Therapy indicated

Answer 6

eGFR <10ml/min

Question 7

Dialysis definition

Answer 7

Dialysis is a process whereby the solute composition of a solution, A, is altered by exposing solution A to a second solution, B, through a semipermeable membrane

Question 8

Pre-Requisites for Dialysis

Answer 8

1. Semipermeable Membrane (Artificial Kidney in Haemodialysis or Peritoneal Membrane)
2. Adequate Blood exposure to membrane
3. Dialysis Access
4. Anticoagulation in Haemodialysis

Question 9

What blood exposure to membrane does does haemodialysis need

Answer 9

extracorporeal blood

Question 10

What blood exposure to membrane does Peritoneal Membrane need in renal replacement therapy

Answer 10

Mesenteric Circulation

Question 11

What Dialysis access does Peritoneal membrane need in renal replacement therapy

Answer 11

peritoneal

Question 12

What is permanent Haemodialysis access

Answer 12

AV Fistula

AV Prosthetic Graft

Question 13

What are temporary Haemodialysis access measures

Answer 13

Tunnelled Venous Catheter and Temp Venous Catheter

Question 14

Patients restrictions for dialysis

Answer 14

Fluid Restriction dictated by Residual Urine Output

Diet Restrict: Potassium, Sodium, Phosphate

Question 15

What is used as dialysis membrane in peritoneal dialysis

Answer 15

Peritoneal Mesothelium

Question 16

What is the most common osmotic agent for ultrafiltration of fluid in peritoneal dialysis

Answer 16

glucose

Question 17

Peritoneal Dialysis Complications

Answer 17

Encapsulating Peritoneal Sclerosis

Ultrafiltration Failure

Gram Pos: Skin

Gram Neg: Bowel

Exit Site infection

Question 18

Indications for Dialysis in End Stage Renal Disease

Answer 18

1. Advanced Uraemia
2. Severe Acidosis
3. Treatment Resistance Hyperkalaemia

Question 19

what is advanced uraemia staged as

Answer 19

GFR 5-10ml

Question 20

severe acidosis classified as

Answer 20

bicarbonate <10mmol

Question 21

What are patients restricted to for fluids in Haemodialysis

Answer 21

500-800ml/24hours

Question 22

Dialysis Related Drugs for Anaemia

Answer 22

Erythropoeitin Injections

IV Iron Supplements

Question 23

Dialysis Related Drugs for Renal Bone Disease

Answer 23

Activated Vit D eg Calcitriol

Phosphate Binders with Meals

Question 24

Complications of Haemodialysis

Answer 24

Arrythmias
Intra Dialytic Hypotension
Clotting
Heparin Related Problems
Exit Site infection
Tunnel Infection
Peritonitis
Hernias

Question 25

Renal Transplant where is transplanted kidney placed into

Answer 25

Iliac Fossa and Anastomosed to Iliac Vessels

Question 26

In renal transplant where do native kidneys go

Answer 26

Remain in Situ

Question 27

Indications for Native nephrectomy

Answer 27

Polycystic Kidney | Chronic Pyelonephritis

Question 28

What immunosuppressive agents can be used in Renal Transplant

Answer 28

Corticosteroid | Calcineurin Inhibitors eg Tacrolimus, Cyclosporine

Question 29

Side effects of corticosteroids in renal transplant

Answer 29

``` hypertension hyperglycaemia infection bone loss gi bleed ```

Question 30

side effects of Tacrolimus in renal transplant

Answer 30

hyperglycaemia AKI tremor

Question 31

side effects of cyclosporin in renal transplant

Answer 31

Hirsutism Hypertension AKI Gout

Question 32

Immunesuppression Protocols for Renal Transplant

Answer 32

Induction: Basiliximab Maintain: Tacrolimus + Mycophenolate and Steroids

Question 33

Is the heart beating after cardiac death

Answer 33

No

Question 34

is the heart beating after brain death

Answer 34

Yes

Question 35

Brain death criteria

Answer 35

``` Coma Unresponsive to Stimuli Apnoea off Ventilation Absence Cephalic Reflexes eg Gag, Pupillary Body Temp above 34 Absence of Drug Intoxication ```

Question 36

Expanded criteria for organ donation

Answer 36

``` Donar >60 Donor 50-59 Hypertension History Death from CVS Accident Terminal Creatinine of >133 ```

Question 37

What is associated with GFR of <60

Answer 37

Older Age and High BMI

Question 38

What mediates rejection after renal transplant

Answer 38

Cell Mediated | Humoral AB Mediated

Question 39

What malignancy can happen after renal transplant

Answer 39

Lymphoma

Question 40

Acute Rejection of Renal Transplant is mediated by

Answer 40

T cell

Question 41

Banff I Acute Rejection of Renal Transplant is categorised as

Answer 41

Tubulointerstitial or ATN Like

Question 42

Banff II Acute Rejection of Renal Transplant is categorised as

Answer 42

Arteritis/Endotheliatitis or Capillaries/Glomerular inflammation

Question 43

Banff III Acute Rejection of Renal Transplant is categorised as

Answer 43

Arterial Fibrinoid Necrosis or Arterial Inflammation

Question 44

Antibody Mediated Rejection of Renal Transplant shows what features

Answer 44

Microvascular Inflammation with Neutrophils, Glomeruli, Peritabular Capillaries Donor Specific Antibodies Positive C4d in Peritubular Capillaries

Question 45

What condition can happen after renal transplant

Answer 45

Diabetes Mellitus

Question 46

What is the most important transplant related infection

Answer 46

Cytomegalovirus

Question 47

Risk factors for BKAN after Renal Transplant

Answer 47

Immunosuppression

Question 48

Treatment for BKAN after Renal Transplant

Answer 48

Antivirals eg Cidofovir or Leflunomide

Question 49

Most common malignancy after renal transplant

Answer 49

Non Melanoma Skin Kaosi Sarcoma Non Hodgkin Lymphoma