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Flashcards in renal replacement therapy Deck (16):
1

dialysis

uraemic toxins efficiently removed from the blood by process of diffusion across a semipermeable membrane towards low concentrations in dialysis fluid

2

what leaves the blood in dialysis

potassium, urea and water

3

what doesnt leave the blood in dialysis

calcium - stays same
sodium - stays same
HCO3- - comes in to the blood

4

haemodialysis

artero-venous fistula in forearm
3 x a week
pts anticoagulated w heparin during rx

5

most common acute complication of haemodialysis

hypotension caused in part by XS removal of extracellular fluid

6

peritoneal dialysis

permanent tube (Tenckoff catheter) placed into peritoneal cavity via subcut tunnel
can be done at night or continuously throughout the day

7

most common serious complication of peritoneal dialysis

bacterial peritonitis often with staph epidermidis
rx w appropriate ABx often given intraperitoneally

8

complications of LT dialysis

CV disease as a result of atheroma and sepsis = leading causes of death
causes of fatal sepsis = peritonitis & staph aureus infec
amyloidosis due to accumulation of B2-microglobin

9

What is B2-microglobin

a component of human leucocyte antigen proteins on most cell membranes
usually excreted by kidneys but is not removed by dialysis membranes - its too big
deposition = carpal tunnel sydrome & joint pains

10

kidney transplant

rx of choice in end stage renal failure
graft survival 80% at 10y
ABO, HLA match req
donor kidney place in left iliac fossa
LT immunosuppressants

11

complications transplant

opportunistic infection
HTN
tumour development

12

drugs given renal transplant

corticosteroids
azothioprine (immunosuppressant)
ciclosporin (immunosuppressant)
tacrolimus (immunosuppressant)
monoclonal antibodies such as antilymphocyte globulin = potent immunosuppressant

13

benefits haemodialysis

live alone / frail
fear of operating machines
unsuitable for PD: abdo surgery, abdo hernia, recurrent PD peritonitis, lack of space at home

14

benefits peritoneal haemodialysis

young / full time work
wanting control of own care
lack of suitable access for HD
severe HF

15

indications for renal replacement in AKI

hyperkalaemia
metabolic acidosis
pulmonary oedema
uraemic pericaditis
severe uraemia

16

renal allograft rejection

hyperacute - preformed antibodies that recognise HLA in donor organ = immediate
acute - mediated by t lymphocytes in first 6 mo - manifests as an inc in serum creatinine
chronic - slow decline in renal function - usually more than 6 mo after transplant - proteinurea