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Junior Medicine- Renal > Renal Replacement Therapy > Flashcards

Renal Replacement Therapy Flashcards

1
Q

What is dialysis?

A

A method of performing filtration artificially

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2
Q

When is dialysis used?

A

In end stage renal failure, or with complications of renal failure

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3
Q

What does dialysis involve?

A

Removing excess fluid, solutes and waste products

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4
Q

What mnemonic is used for the indications of acute dialysis?

A

AEIOU
Acidosis (not responding to Tx)
Electrolyte disturbance (severe hyperkal)
Intoxication (OD on medication)
Oedema (unresponsive pulmonary oed.)
Uraemia symptoms (seizures, reduced consciousness)

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5
Q

What are the indications for long term dialysis?

A
  • CKD G5

- any of the AEIOU indications continuing log term

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6
Q

What dialysis options are there?

A
  • Continuous ambulatory peritoneal dialysis
  • Automated peritoneal dialysis
  • Haemodialysis
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7
Q

Summarise peritoneal dialysis.

A
  • Peritoneal membrane acts as a filtration membrane
  • Dialysis solution containing dextrose is added to the peritoneal cavity
  • Waste products leave the blood and enter the fluid by ultrafiltration
  • The dialysis solution is then drained
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8
Q

What catheter is used in peritoneal dialysis?

A

Tenckhoff catheter

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9
Q

How does continuous ambulatory peritoneal dialysis work?

A

2L of dialysis fluid is put into the cavity, and is changed four times a day, it is never simply removed

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10
Q

How does automated peritoneal dialysis work?

A
  • Occurs overnight

- A machine continuously replaces the fluid over 8-10 hours

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11
Q

What are the complications of peritoneal dialysis?

A
  • bacterial peritonitis (common and serious)
  • peritoneal sclerosis (thick/scarred peritoneal membrane)
  • ultrafiltration failure (dextrose absorbed, reducing the filtration gradient)
  • weight gain (absorb the carbs in the solution)
  • psychosocial effects
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12
Q

Summarise haemodialysis.

A
  • Blood filtered by machine
  • 4 hours a day, 3 days a week
  • uses a tunnelled, cuffed catheter or an AV fistula
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13
Q

Where is the tunnelled cuffed catheter in haemodialysis?

A
  • Subclavian or jugular vein

- Tip sits in either SVC or RA of the heart

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14
Q

What are the complications of the cuffed catheter?

A
  • Blood clot in the catheter

- Infection

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15
Q

Where might an AV fistula be placed?

A
  • Radio-cephalic

- Brachio-cephalic

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16
Q

How do you examine an AV fistula?

A
  • Skin integrity
  • Aneurysms
  • Palpable thrills
  • Machinery murmur
17
Q

What are the complications of an AV fistula?

A
  • Aneurysm or stenosis
  • Infection
  • Thrombosis
  • STEAL Syndrome
  • High output heart failure
18
Q

What is STEAL syndrome?

A
  • Inadequate blood flow to the limb distal to an AV fistula
  • Blood flows from arterial system to venous system, proximal to the affected part of the limb
  • Ischaemia
19
Q

What is high output heart failure?

A
  • Blood flows rapidly from arterial to venous system through the AV
  • This means rapid blood return to the heart
  • Increased preload
  • Myocardial hypertrophy and HF
20
Q

How many years does transplant add compared to dialysis?

A

10 more years to longevity

21
Q

How are kidney donors matched?

A

Human leukocyte antigen (HLA) type A, B and C on chromosome 6

22
Q

Where is a kidney put in, and what scar does it leave?

A
  • Anterior abdomen, iliac fossa
  • Connected to external iliac vessels (A+V)
  • Kidney anastamosed directly to bladder
  • Leaves a ‘hockey stick scar’
23
Q

What is a Pt given post transplant?

A

Lifelong immunosuppression:

  • Tacrolimus
  • Mycophenolate
  • Prednisolone (ALL THREE)
24
Q

What are the complications of transplant rejection?

A
  • Rejection leading to damage and failure of function

- Electrolyte imbalances

25
Q

What are the complications of immunosuppression?

A
  • Ischaemic heart disease
  • T2DM (steroids)
  • Infections (more and worse)
  • Unusual infections (TB, CMV…)
  • Non-Hodgkin’s lymphoma
  • Squamous cell carcinoma of the skin

Junior Medicine- Renal (6 decks)

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