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Year 2- Urinary > Renal Replacement Therapy > Flashcards

Renal Replacement Therapy Flashcards

1
Q

The kidneys play a role in the activation of which vitamin?

A

Vitamin D

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2
Q

What do the kidneys produce which helps to maintain haemoglobin?

A

Erythropoietin

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3
Q

Is end-stage kidney disease reversible?

A

No

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4
Q

At what stages of CKD may the patient become symptomatic?

A

Usually asymptomatic until around stage 4/5

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5
Q

What is the name of the syndrome of advanced CKD?

A

Uraemia

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6
Q

What are the two types of renal replacement therapy?

A

Dialysis
Kidney transplant

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7
Q

At what eGFR is renal replacement therapy usually indicated at?

A

eGFR <10m/lmin

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8
Q

What are the two types of dialysis?

A

Haemodialysis
Peritoneal dialysis

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9
Q

Which type of renal replacement therapy has the best outcomes in terms of mortality and morbidity?

A

Renal transplant

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10
Q

Which type of dialysis can be done at home?

A

Haemodialysis

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11
Q

If a patient is on haemodialysis and comes to the hospital/satellite unit for their treatment rather than doing it at home, how many times per week do they go in?

A

Three times per week

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12
Q

What are the two types of peritoneal dialysis?

A

Continuous ambulatory peritoneal dialysis (CAPD)
Intermittent peritoneal dialysis (IPD)

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13
Q

What is dialysis?

A

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

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14
Q

What are the two principles of dialysis?

A

Diffusion
Ultrafiltration

->dialysis may involve both or one or the other

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15
Q

List the things required for dialysis to occur.

A
  1. Semi-permeable membrane
  2. Adequate blood exposure to the membrane
  3. Dialysis access
  4. Anticoagulation in haemodialysis
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16
Q

Name two permanent ways for haemodialysis access.

A

Arteriovenous fistula
AV prosthetic graft

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17
Q

Name two temporary ways for haemodialysis access.

A

Tunnelled venous catheter
Temporary venous catheter

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18
Q

Which electrolytes don’t get changed about too much in dialysis?

A

Sodium and calcium

->potassium gets moved slightly

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19
Q

Which two components are not present in the dialysate (dialysis solution) and need to be shifted over from the blood?

A

Creatinine and urea

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20
Q

What is there a lot of in the dialysate which moves over to the blood?

A

Bicarbonate

->this is because the blood of patient’s on dialysis can go acidic after dialysis for a bit

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21
Q

What are some of the restrictions for dialysis patients?

A

Fluid restriction
Diet restriction

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22
Q

What is restricted in the diet of dialysis patients?

A

Potassium
Sodium
Phosphate

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23
Q

How much fluid can be removed from a patient during dialysis before they start to become unwell due to low BP?

A

2.5-3L

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24
Q

Where is the catheter for a patient on haemodialysis?

A

AV fistula or graft in the arm
Neck

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25
Q

Where is the catheter for a patient on peritoneal dialysis?

A

Peritoneum in the pelvic region

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26
Q

In CAPD, does dialysis occur during the day or night?

A

Day

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27
Q

In APD, does dialysis occur during the day or night?

A

Night

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28
Q

What happens in CAPD?

A

You fill your abdomen with dialysate, let it remain there for the dwell time, then drain the fluid. Gravity moves the fluid through the catheter and into and out of your abdomen.

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29
Q

What happens in APD?

A

Machine called an automated cycler exchanges for you at night while you sleep. It fills your abdomen with dialysate and lets it dwell there. Then it drains the fluid into a sterile bag that you empty in the morning.

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30
Q

What are the complications of peritoneal dialysis?

A

Exit site infection
Peritonitis
Ultrafiltration failure
Encapsulating peritoneal sclerosis

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31
Q

If there is peritoneal dialysis peritonitis, if the bacteria is gram negative, where is it’s origin?

A

Bowel origin

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32
Q

If there is peritoneal dialysis peritonitis, if the bacteria is gram positive, where is it’s origin?

A

Skin origin

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33
Q

PD membrane is exposed to constant inflammation which can result in complications.
Therefore, after how long is PD usually stopped?

A

2-3years

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34
Q

What should fluid look like in PD before and after?

A

Should be clear in both

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35
Q

If PD fluid is cloudy, what is this usually indicative of

A

Infection

36
Q

What is the treatment for PD peritonitis?

A

Antibiotics, usually Vancomycin to cover gram-positive infections and Ciprofloxacin to cover gram-negative

37
Q

What are the indications for starting dialysis in patients with end-stage kidney disease?

A

Advanced uraemia (GFR 5-10ml/min)
Severe acidosis (bicarbonate <10mmol/L)
Treatment resistant hyperkalaemia (K>6.5 mmol/L)
Treatment resistant fluid overload

38
Q

What is the fluid balance for patients on haemodialysis?

A

Usually restricted to 500-800ml/24hrs = urine output + insensible losses

39
Q

What is the fluid balance for patients on peritoneal dialysis?

A

Usually more liberal intake as continuous ultrafiltration is often achieved

40
Q

Patients on dialysis often need to take a lot of drugs. This is because dialysis is trying to replace the function of the kidneys but the kidneys have many different functions.

Which drugs do dialysis patients need to take to prevent anaemia?

A

Erythropoietin injections
IV iron supplements

41
Q

Patients on dialysis often need to take a lot of drugs. This is because dialysis is trying to replace the function of the kidneys but the kidneys have many different functions.

Which drugs do dialysis patients need to take to prevent renal bone disease?

A

Activated Vitamin D (calcitriol)
Phosphate binders with meals (CaCo3)

42
Q

Patients on dialysis often need to take a lot of drugs. This is because dialysis is trying to replace the function of the kidneys but the kidneys have many different functions.

Which other drugs will dialysis patients need to take?

A

Heparin- to prevent clotting of the socket
Water soluble vitamins
Often require antihypertensive drugs

43
Q

What are some of the potential cardiac complications of haemodialysis?

A

Intra-dialytic hypotension and cramps
Arrhythmias

44
Q

What are some of the potential coagulation complications of haemodialysis?

A

Clotting of vascular access
Heparin related problems

45
Q

What are some of the other potential complications of haemodialysis?

A

Allergic reactions to dialysers and tubing
Catastrophic complications e.g. haemorrhage (rare)

46
Q

What are some of the potential complications of peritoneal dialysis?

A

Infection- exit site, tunnel infection, peritonitis
Tube malfunction, abnormal wall herniae

47
Q

How is it decided which type of dialysis a patient might have?

A

Patient choice- shared decision making based of effectiveness, etc.
Involves a lot of patient education

48
Q

When may someone be unsuitable for peritoneal dialysis?

A

If they have had multiple abdominal surgeries
Previous problems with vascular access
Stenosis of central vessels

49
Q

Which type of dialysis can be done at home?

A

Haemodialysis

50
Q

In Scotland, is organ donation opt in or opt out?

A

Opt out

51
Q

Describe what happens in a renal transplant process.

A

Transplanted kidneys is placed into the iliac fossa and anastomosed to iliac vessels and the ureter to the bladder

52
Q

What is done with the kidney after being taken from a living donor?

A

Preservation of the kidney using cold storage solutions
Oedema of the kidneys is minimised
Tissue integrity is preserved

53
Q

Can the kidney survive long between taking it from the donor and inserting it into the patient?

A

Quicker the better as ischaemia can develop

->longer the wait, less likely the kidney will be good enough to transplant

54
Q

What are some of the transplant surgical complications?

A

Bleeding
Arterial thrombosis
Venous thrombosis
Lymphocele formation
Urine leak
Infection

55
Q

What can be done to interfere with the antigens not recognising the new kidney and provoking an immune reponse?

A

-Calcineurin inhibitors (inhibition of signal 1)
-Co-stimulation using the CTLA-4 immunoglobulin (inhibition of signal 2)
-Interference with CD25 (inhibition of signal 3)

56
Q

What can be used as antiproliferative agents in a kidney transplant?

A

Azathioprine
Mycophenolic acid

57
Q

Commonly, to summarise, which drugs are given as immunosuppressive agents in a kidney transplant?

A

-An induction agent e.g. basiliximab
-A calcineurin inhibitor e.g. tacrolimus
-An antiproliferative agent e.g. mycophenolate mofetil

58
Q

What are the side effects of corticosteroids?

A

Hypertension
Hyperglycaemia
Infections
Bone loss
GI bleeding

59
Q

What are the side effects of Tacrolimus?

A

Hyperglycaemia
AKI
Tremor

60
Q

What are the side effects of cyclosporin?

A

Hypertension
AKI
Gout

61
Q

What are the side effects of mycophenolate mofetil?

A

Cytopenia
GI upset

62
Q

What are the side effects of sirolimus?

A

Lipidogenic
Diabetogenic
Pneumonia

63
Q

In immunosuppression protocol, which drug is used in the induction?

A

Basiliximab

64
Q

In immunosuppression protocol, which drug is used in the maintenence?

A

Tacrolimus
Mcycophenolate
Steroids

65
Q

What is meant by a deceased donor?

A

Someone donating organs after brain death when the heart is still beating.
Some after cardiac death when heart is no longer beating

66
Q

What is meant by a living donor?

A

A match, usually related to the patient but can be unrelated

67
Q

What is meant by expanded criteria of organ donation?

A

Helps to identify organs which are not as likely to work effectively

68
Q

What is the expanded criteria for organ donation?

A

Donors aged > 60y
Donors aged 50-59 with history of hypertension, death from a cerebrovascular accident or a terminal creatinine >133

69
Q

What is better for the patient- living donor donation or deceased donor donation?

A

Living donor

70
Q

Waiting time for a kidney donor can vary based on what?

A

Matches, geographic location, blood type, ethnicity

71
Q

Do transplants tend to be more common in older or younger patients w ESKD?

A

Younger patients as less risk of complications

72
Q

Briefly describe what is meant by paired donation?

A

Two groups of people, one needing a transplant and the other willing to donate but it does not match, link up with another pair in the same position in which the two donors will match the other’s recipient

->can be done in bigger groups known as pooled donation

73
Q

What are some things that are looked at in a living donor before they are able to donate their kidney?

A

Age
Sex
Ethnicity
Hypertension
Smoker
High BMI
GFR

74
Q

What are some potential complications after renal transplantation?

A

Rejection
Cardiovascular issues
Infection
Malignancy

75
Q

What are the two types of renal mediated rejection?

A

T cells

or

Acute antibody mediated rejection

76
Q

Which classification is used for renal rejection?

A

Banff classification

77
Q

What is the difference between type 1 and 2 renal rejection according to Banff classification?

A

Type 1- tubulointerstitial rejection without arteritis
Type 2- vascular rejection with arteritis

78
Q

What is the treatment for organ rejection?

A

Immunosuppression by means of steroids

79
Q

What condition can occur after any transplantation?

A

Diabetes due to use of steroids and immunosuppression

->higher risk if recipient has high BMI

80
Q

When after transplantation is infection risk higher?

A

Higher in first 3-6 months after transplant

81
Q

Name an infection which can occur after transplant.

A

Cytomegalovirus

82
Q

How can cytomegalovirus affect patients who have undergone an organ replacement?

A

Transmission from donor tissue

or

Reactivation of latent virus

83
Q

BK virus can also infect patients after organ transplant.
How can this manifest?

A

Ureteral stenosis
Interstitial nephritis
ESRF

84
Q

What are some of the risk factors for BK virus?

A

Intense immunosuppression
Older age
Male
Ureteral stents

85
Q

Treatment for BK virus?

A

Reduction in immunosuppressants

86
Q

Over time, the risk of malignancy increasing following transplantation.
Which types are most common?

A

Skin
Lymphoma

87
Q
A

Year 2- Urinary (22 decks)

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