Renal replacement therapy

Question 1

Describe the function of kidneys in activating vitamin D

Answer 1

The kidneys convert vitamin D into calcitrol which is it’s active form - this is crucial for calcium absorption and maintaining phosphorus levels in out blood, this ensures strong healthy bones

Question 2

Describe the production of erythropoetin

Answer 2

The kidneys produce erythropoetin which stimulates production of red blood cells in the bone marrow
This is important in maintaining adequate oxygen levels in the body

Question 3

What is the definition of end stage renal disease

Answer 3

When there is so much damage to a person’s kidney that it impairs the usual function of excretion of waste and other functions which makes the patient require dialysis or transplant to live healthy

Question 4

What is uraemia

Answer 4

The syndrome of advanced chronic kidney disease

Question 5

What are the cardinal symptoms of uraemia

Answer 5

Malaise and fatigue although the symptoms can affect almost every organ

Question 6

When is renal replacement therapy indicated

Answer 6

When eGFR is less than 10

Question 7

What are the different types of renal replacement therapy

Answer 7

Transplant
Haemodialysis - most common
Peritoneal dialysis
Conservative kidney management

Question 8

What is conservative kidney management

Answer 8

For very old, frail individuals , dialysis may cause more harm than good so it is better suited that their symptoms get treated with medication

Question 9

Define dialysis

Answer 9

A process where the solute composition of a solution A is modified by exposing another solution to solution A through a semipermeable membrane

Question 10

What is required for dialysis

Answer 10

Semipermeable membrane which is meant to act as the filtration system of the kidney
Adequate blood supply to the machine
Dialysis access
Anticoagulation in haemodialysis

Question 11

Where is the dialysis access in haemodialysis compared to peritoneal dialysis

Answer 11

Hameodialysis - vascular access
Peritoneal dialysis - peritoneal access

Question 12

What restrictions are in place for dialysis patients

Answer 12

Fluid restrictions and dietary restriction to limit electrolytes coming through the diet

Question 13

What are complications of haemodialysis

Answer 13

Arrhythmias, hypotension and cramps

Issues with coagulation - clotting of the vascular access and issues with the heparin

Question 14

What is the most common osmotic agent in peritoneal dialysis to be used for ultrafiltration

Answer 14

Glucose and it’s high osmolarity is used to pull fluid out towards it

Question 15

What are the complications of peritoneal dialysis

Answer 15

Infections - risk of bactria getting into the tube during drainage

Peritonitis

Encapsulating peritoneal sclerosis

Question 16

What is the symptoms of peritoneal dialysis (PD) peritonitis

Answer 16

Abdominal pain and cloudy urine

Question 17

What is encapsulating peritoneal sclerosis

Answer 17

mesentery and peritoneum become thickened and calcified which causes abdominal pain and obstruction in the bowel - usually occurs in patients who have been on dialysis for more than 5 years

Question 18

What are the indications for dialysis in end stage renal disease

Answer 18

Advanced uraemia - advanced CKD - GFR 5-10

Severe acidosis with bicarbonate less than 10 mmol/l

Hyperkalaemia and fluid overload which is treatment resistant

Question 19

What drugs should be taken for anaemia associated with the iron loss caused by dialysis

Answer 19

Erythropoetin injections and IV iron supplements

Question 20

What drugs should be given for renal bone disease associated with dialysis

Answer 20

Calcitrol (activated vitamin D)
Phosphate binders with meals

Question 21

What anticoagulant is commonly given with dialysis

Answer 21

Heparin

Question 22

What is ultrafiltration

Answer 22

Forcing fluid across the membrane to move some fluid out from the blood