Renal Replacement Therapy

Question 1

What is the average life expectancy of a patient with end stage renal failure that does not receive RRT?

Answer 1

6 months

Question 2

What is usually the mean GFR at the start of dialysis?

Answer 2

8-10ml/min

Question 3

Dialysis is usually provided via what type of venous access?

Answer 3

AV fistula

Question 4

If dialysis is needed as an immediate treatment there is no time to make an AV fistula. How is venous access established in these cases?

Answer 4

Tunnelled venous catheter

Question 5

An AV fistula requires how long to mature after surgery before it can be used?

Answer 5

6-12 weeks

Question 6

The presence of an AV fistula may limit blood flow to the distal arm. What is this complication known as?

Answer 6

Steal syndrome

Question 7

Tunnelled venous catheters come with a high risk of infection, particularly with which bacteria?

Answer 7

Staph aureus

Question 8

How often is dialysis needed in order to be an effective treatment?

Answer 8

4 hours of treatment, 3 times per week

Question 9

The annual mortality of dialysis patients is 20%- this is most commonly due to what?

Answer 9

Cardiovascular disease

Question 10

Haemodialysis is the most common form of RRT, and works mainly on what scientific principle?

Answer 10

Diffusion

Question 11

Which solutes are removed from the blood in haemodialysis?

Answer 11

Urea, creatinine, sodium and potassium

Question 12

Other than water, which solutes are added to the blood in haemodialysis?

Answer 12

Bicarbonate, glucose, sodium and potassium

Question 13

Too rapid a correction of uraemia (i.e. too much dialysis too soon) leads to what complication? What can this cause?

Answer 13

Disequilibrium syndrome - causes cerebral oedema and seizures

Question 14

What effect does haemodialysis have on blood pressure?

Answer 14

Decreased (hypotension)

Question 15

Haemofiltration works mainly on what scientific principle?

Answer 15

Convection

Question 16

What is the main advantage of haemofiltration over haemodialysis?

Answer 16

Haemofiltration causes less haemodynamic instability

Question 17

In peritoneal dialysis, the high concentration of what in the dialysis solution draws waste products out of the blood?

Answer 17

Glucose

Question 18

Which type of peritoneal dialysis involved 4 x 2l bag exchanges throughout the day, while the patient goes around their normal activities?

Answer 18

Continuous ambulatory peritoneal dialysis

Question 19

Which type of peritoneal dialysis involves a dialysis machine filling and draining the abdomen while the patient sleeps?

Answer 19

Automated peritoneal dialysis

Question 20

What is the most significant complication of peritoneal dialysis?

Answer 20

Dialysis related peritonitis

Question 21

Peritoneal membrane failure in peritoneal dialysis may lead to an inability to remove enough water. What complication does this lead to?

Answer 21

Fluid overload

Question 22

Peritoneal membrane failure in peritoneal dialysis may lead to an inability to remove enough solute. What is the most significant complication that this leads to?

Answer 22

Uraemia

Question 23

What effect does peritoneal dialysis have on blood glucose levels?

Answer 23

Increased (hyperglycaemia)

Question 24

Is there an age limit on renal transplants?

Answer 24

No

Question 25

What are the 3 absolute contraindications to renal transplantation?

Answer 25

Active infection, cancer or severe comorbidity

Question 26

Which type of renal transplant comes with the highest risk of delayed graft function?

Answer 26

Donor after cardiac death

Question 27

Which type of renal transplant has the best outcomes?

Answer 27

Living donor transplants

Question 28

Where is a transplanted kidney inserted into?

Answer 28

Iliac fossa

Question 29

A transplanted kidney is attached to which vessels?

Answer 29

External iliac artery and vein

Question 30

After a renal transplant, patients are usually back to full activities in how long?

Answer 30

3 months

Question 31

Delayed graft function of a renal transplant is usually due to what?

Answer 31

Acute tubular necrosis

Question 32

In delayed graft function, how long does it usually take for the transplant to start to work?

Answer 32

10-30 days

Question 33

What is the term for a renal transplant which never starts to work?

Answer 33

Primary non-function

Question 34

Which type of transplant rejection is more common: humoral or cellular?

Answer 34

Cellular

Question 35

How is acute transplant rejection treated?

Answer 35

High dose IV methylprednisolone

Question 36

Acute transplant rejection which is humoral (antibody mediated) often requires what other treatment in addition to intense immunosuppression?

Answer 36

Plasma exchange

Question 37

Basiliximab is an immunosuppressant medication which is used as induction immunosuppression before renal transplant. This blocks which aspect of the immune system?

Answer 37

IL-2

Question 38

What immunosuppressant is given during the renal transplant procedure?

Answer 38

IV methylprednisolone

Question 39

After a renal transplant, most patients are maintained on 'triple therapy' immunosuppression. What comprises this therapy?

Answer 39

Calcineurin inhibitor, anti-metabolite and prednisolone

Question 40

What are two examples of calcineurin inhibitors?

Answer 40

Tacrolimus and ciclosporin

Question 41

What are two examples of anti-metabolites?

Answer 41

Azathioprine and mycophenolate (MMF)

Question 42

Calcineurin inhibitors work by inhibiting which aspect of the immune system?

Answer 42

T cells

Question 43

Calcineurin inhibitors are most likely to cause what type of side effects? Give examples.

Answer 43

Neurological side effects e.g. tremor, confusion

Question 44

Which immunosuppressant drug causes gum hypertrophy?

Answer 44

Ciclosporin

Question 45

Anti-metabolites work by inhibiting which aspect of the immune system?

Answer 45

Lymphocytes

Question 46

What are some potential side effects of anti-metabolite drugs?

Answer 46

Agranulocytosis and hepatitis

Question 47

Prophylaxis is given against which infection post-renal transplant?

Answer 47

Pneumocystis pneumonia

Question 48

Infection with what is an important cause of morbidity in the first 3 months of immunosuppression after a renal transplant due to association with early graft loss?

Answer 48

CMV

Question 49

Which type of cancer is especially common post-renal transplant and should be monitored for with regular reviews?

Answer 49

Non-melanoma skin cancers, especially SSC

Question 50

Post-renal transplant lymphoproliferative disease is usually related to infection with what?

Answer 50

EBV