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Abdo Medicine > Renal Replacement Therapy > Flashcards

Renal Replacement Therapy Flashcards

1
Q

What methods of renal replacement therapy are there?

A

Tunneled central venous catheter
Arteriovenous fistula
Peritoneal dialysis
Renal transplant

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2
Q

What are the indications for renal replacement therapy?

A

GFR of 30mL/min or less (30-40ml in DM)

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3
Q

What are the indications for acute haemodialysis?

A

A- acidosis (refractory to management)
E- electrolyte abrnomalities (hyperkalaemia refractory to management)
I- intoxication: lithium, salicylates
O- fluid overload (refractory to diuretics)
U- uraemia: pericarditis or pleuritis, uraemic bleeding diathesis due to platelet dysfunction, encephalopathy or confusion.

(Also- HTN refractory to anti-HTN drugs)

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4
Q

What are the complications of haemodialysis?

A

Bacteraemia: especially with (non)-tunnelled venous catheters. Risk metastatic infection with staph aureus infection.

Bleeding: heparin used as anticoagulant. May require protamine sulphate.

Fistula problems: Thrombosis, stenosis

Dialysis washout: Due to removal of too much fluid (excessive ultrafiltration) or fluid removal being too rapid –> hypotension, chest pain, leg cramps, nausea and headache.

Dialysis related amyloidosis: Sounds complicated, dont think we need to know this one.

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5
Q

What are the complications of peritoneal dialysis?

A

Bacterial peritonitis: Common (~1 every patient year). Abdo pain or cloudy dialysates. Fever may be absent.

Failure of dialysis: Due to peritoneal sclerosis

DM: Due to absorption of glucose from dialysate

Local complications: Abdominal wall hernia, fluid leakage into surrounding tissue, catheter exit site infections

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6
Q

What is the management of bacterial peritonitis from peritoneal dialysis?

A

Intraperitoneal antibiotics.

May require removal of dialysis catheter and a change in dialysis modality.

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7
Q

How would you tell if an AV fistula is currently patent?

A

Palpate- thrill

Auscultate- bruit

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8
Q

What would a tunnelled central venous catheter look like?

A

L or R subclavian area- through subclavian vein

Scar above from insertion

Double-lumen catheter

NB Always comment on presence or absence of infectoin

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9
Q

What are the indications for a tunnelled central venous catheter?

A

Intermittent dialysis while an AV fistula matures

Patients whose veins are not suitable to the creation of an AV fistula who require haemodialysis.

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10
Q

What is the preferred form of vascular access for haemodialysis?

A

AV fistula

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11
Q

Where would you find an arteriovenous fistula?

A

Non-dominant arm

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12
Q

How long before you can use an AV fistula after its creation?

A

Months- hence need for haemodialysis referral long before requirement

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13
Q

What are signs of uraemia?

A

Altered mental status

Asterixis (metabolic encephalopathy)

Excoriation marks (secondary to pruritis)

Tachypnoea (metabolic acidosis with resp compensation)

Pericardial rub (uraemic pericarditis)

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14
Q

Define chronic kidney disease

A

Impaired renal function >3 months based on abnormal structure or function, or GFR 3 months with or without evidence of kidney damage

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15
Q

How many stages of CKD are there?

A

5

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16
Q

What is stage 5 RF?

A

Established (end-stage) renal failure: GFR

17
Q

What are the most common causes of RF in the UK?

A

DM: 20% UK. Type II>I

Glomerulonephritis: IgA nephropathy most common. Systemic disorders- SLE, vasculitis

Unknown

HTN or renovascular disease

Pyelonephritis and reflux nephropathy

Miscellaneous (drugs, paraproteinaemia)

PCKD: Most common inherited form

18
Q

How would you manage a patient with CKD?

A
  1. Identify and treat reversible causes: Stop nephrotoxic drugs, address high Ca and CV risk, tight glucose control in DM
  2. Limit progression and complications:
    BP (aim
19
Q

What is haemodialysis?

A

Blood passe dover a semi-ermeable membrane against dialysis fluid flowing in opposite direction, creating a concentration gradient via diffusion.

Ultrafiltration for excess fluid

20
Q

What is peritoneal dialysis?

A

Uses peritoneum as a semipermeable membrane. Addition of osmotic agents (e.g. glucose) enables ultrafiltration.

Allows patient more freedom

21
Q

What is the name of the catheter used in peritoneal dialysis?

A

Tenchkhoff catheter- inserted into peritoneal cavity

22
Q

What are the main complications of renal replacement therapy overall

A

CV disease: Main COD

Malnutrition

Renal bone disease: High bone turnover, renal osteodrystrophy (increased bone turnover from secondary hyperparathyroidism, osteomalacia and reduced bone turnover)

Infection

Malignancy: Increased incidence in dialysis patients

23
Q

What is the name of the catheter used for tunnelled central venous catheter in dialysis?

A

Tessio line- 2 lines, enters internal jugular vein

Abdo Medicine (14 decks)

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