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Renal Replacement Therapy Flashcards

(59 cards)

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1
Q

What are the functions of the kidneys?

A 
Excretion of nitrogenous waste products
Maintenance of acid/base balance
Control of BP 
Drug metabolism and excretion 
Vitamin D activation 
Production of erythropoietin
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2
Q

When is CKD typically symptomatic?

A

At stage 4/5

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3
Q

What is uraemia?

A

The syndrome of advanced CKD

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4
Q

What is the earliest and most cardinal symptoms of uraemia?

A

Fatigue

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5
Q

What are the symptoms of CKD?

A

Typically asymptomatic until stage 4/5

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6
Q

When is RRT usually indicated with eGFR?

A

<10ml/min

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7
Q

What are indications for dialysis in ESRD?

A

Advanced uraemia, (GFR 5-10 ml/min)
Severe acidosis (bicarbonate <10 mmol/l)
Treatment resistant hyperkalaemia (K >6.5 mmol/l)
Treatment resistant fluid overload
Nephrologist’s clinical judgment is important

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8
Q

What are the types of RRT?

A

Renal transplant
Haemodialysis
Peritoneal dialysis
Conservative kidney management

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9
Q

What are the 2 types of haemodialysis?

A

Home

and satellite/hospital

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10
Q

What are the 2 types of peritoneal dialysis?

A

Continuous ambulatory peritoneal dialysis (CAPD)

Intermittent peritoneal dialysis (IPD)

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11
Q

What are the 2 molecular processes crucial for haemodialysis?

A

Ultrafiltration

Diffusion

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12
Q

Describe diffusion in haemodialysis

A

Process whereby solute composition of a solution A is altered by exposing solution A to solution B through a semi-permeable membrane
With time solution A equilibrates with solution B

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13
Q

Describe the process of ultrafiltration in haemodialysis/

A

Take the same semi-permeable membrane and apply a pressure gradient
to regulate fluid balance

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14
Q

Are ultrafiltration and diffusion applied at the same time or separately?

A

Same time

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15
Q

What are the pre-requisites for dialysis?

A

Semi-permeable membrane
Adequate blood exposure to membrane
Dialysis access
Anticoagulation

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16
Q

What are the permanent types of haemodialysis access?

A

Arteriovenous fistula

AV prosthetic graft

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17
Q

What are the temporary types of haemodialysis access?

A

Tunnelled venous catheter

Temporary venous catheter

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18
Q

What is an arteriovenous fistula?

A

When artery is anastomosed to a vein
Pressure is transmitted from artery to the vein causing hypertrophy
Has strong blood flow through it

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19
Q

When is AV prosthetic graft indicated?

A

In failed AV fistula

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20
Q

What is the disadvantages of AV prosthetic graft?

A

Foreign body

So increased risk of infectioqn

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21
Q

What direction does the dialysate move in?

A

Opposite to the blood flow to pull the solutes out of the blood

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22
Q

What is the fluid restriction in haemodialysis patients?

A

500-800ml/24 hours

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23
Q

What is the fluid restriction in peritoneal dialysis?

A

Usually more liberal as continuous ultrafiltration is often achieved

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24
Q

What restrictions are dialysis patients under?

Study These Flashcards
A 
Fluid restriction 
Dietary restriction of 
Potassium 
Sodium 
Phosphate
25
What are potential complications of haemodialysis?
CVS problems - arrhythmias, hypotension and cramps Coagulation - clotting or heparin related problems Other - allergic reactions to dialysis and tubing, catastrophic dialysis accidents
26
What is the predominant home therapy for RRT?
Peritoneal dialysis
27
What type of access is present in peritoneal dialysis?
Tunnelled cuffed catheter into the pelvic region
28
How does peritoneal dialysis work?
Balanced dialysis solution is instilled into the peritoneal cavity using the peritoneal mesothelium as a dialysis membrane
29
How does peritoneal dialysis control ultrafiltration?
Through glucose in the solution being an osmotic agent | Remember there is no pressure from the apparatus like in haemodialyis with the dialysis machine
30
Describe CAPD peritoneal d?
Involves several exchanges of fluid throughout the day
31
Describe APD peritoneal D?
Occurs at night with a machine | drains same amount of times but quicker with less filtration at each time
32
What are the complications of peritoneal D?
Exit site infection PD peritonitis Ultrafiltration failure Technical related problems - tube related or abdominal hernia
33
What is the most commonest route of infection with gram positive PD peritonitis?
Skin contamination
34
What is the commonest route of infection with gram negative PD peritonitis?
Bowel origin
35
What other drugs should be considered in dialysis?
Erythropoietin injections IV iron supplements for anaemia - Activated Vitamin D (eg calcitriol) - Phosphate binders with meals (CaCo3)for Vit D deficiency Heparin Water soluble vitamins ? antihypertensives
36
Why does activated vitamin D have to be given in CKD?
Because activation of vitamin D occurs in the kidney | In cDK kidney not working so have to activate prior
37
What considerations have to be made when putting a patient on dialysis?
Patient choice | Perceptions of effectiveness
38
What are the limitations of dialysis?
It is a woeful substitute for the kidneys
39
Where are kidney transplaneted?
Into the iliac fossa
40
What is used as the membrane in peritoneal dialysis?
Peritoneal membrane
41
What is the problem with using the peritoneal membrane for dialysis?
It does not apply pressure for ultrafiltration
42
What happens to the native kidneys in transplantation?
They remain in situ
43
How does cold ischaemic time of the kidney related to the success of the transplant?
The longer the cold ischaemia time - less successful
44
What are potential surgical complications of renal transplant?
``` Bleeding Arterial thrombosis Venous thrombosis Urine leak Hernia Infection - more common ```
45
What are the contraindications for renal transplant?
Cancer with metastases Active infection HIV with viral replication Congestive heart failure
46
What immunosuppression drugs are given after transplantation?
``` Calcineurin inhibitors Anti-proliferative agents mTOR inhibitors Glucocorticosteroids monoclonal antibodies ```
47
What are the types of deceased donors?
Donation after brain death | Donation after cardiac death
48
What are the types of living donors?
Living related donor | Living unrelated donor
49
What is the criteria for brain death?
``` Coma - unresponsive to stimuli Absence of cephalic reflexes Apnoea of ventilator Body temperature above 34 degrees Absence of drug intoxication ```
50
What is paired donation?
When donor A want to donate to recipient B but is not an exact match Donor B is in the same position with recipient B Donor A is a match with recipient B and vice versa so switch
51
What is pooled donation?
Pooled donation is where more than two pairs of donors and recipients are involved in the swap.
52
Who is transplantation not usually suitable for?
Elderly
53
What are the types of risk involved with transplantation?
Rejection Infection Malignancy Delayed graft function
54
How is rejection treated with?
High dose steroids and immunosuppression
55
What are the two types of transplantation rejection?
Antibody mediated | Cell mediated
56
What is cytomegalovirus?
Most important transplant related infection Affects around 8% of transplant recipients Despite prophylaxis treatment high mortality and morbidity if left untreated
57
What is the best way to treat ESRD?
Renal transplantation
58
Are there enough donors for transplantation?
No demand is much higher than supply
59
What are Extended criteria donors?
Donors with medical complexities Donor aged >60yrs Or donor aged 50-59 years with history of hypertension, death from cerebrovascular accident or terminal creatinine of >132umol/L

Urology (13 decks)

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