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List two potential complications of severe CKD

Advanced CKD can affect any system of the body. The two commonest complications are a)
normochromic normocytic anaemia b) renal osteodystrophy


How is renal osteoitis fibrotica cystica treated?

The principles of treatment for bone disease include measures aimed at lowering serum
phosphate. These will include dietary restriction and the use of oral phosphate binders to
decrease phosphate absorption from the gut. A number of these products are commercially
available some of which also contain a source of alimental calcium. Once the phosphate is
controlled measures should be taken to ensure that calcium is within the acceptable range
potentially with the use of activated vitamin D supplements. If the parathyroid hormone
remains unacceptably high despite these measures surgical parathyroidectomy may be
required. A new class of drugs known as calcium emetics may also be useful in
suppressing the parathyroid hormone


Q11.11 Briefly describe the principles of peritoneal dialysis

The peritoneal membrane acts as a semi-permeable membrane
Dialysis fluid containing an osmotic agent allows water to be removed from patients
membrane capillaries by osmosis. Solutes removed from patients capillaries by diffusion
and convection into the dialysis fluid.


What is the process that causes acute transplant rejection?

The transplanted kidney can be rejected by either a process of acute cell mediated
immunity or acute humoral immunity. Cell medicated rejection is the most common form of
early rejection. When the rejection is very severe acute vascular rejection can also occur.


How would you diagnose acute rejection?

A transplant kidney biopsy
Acute cellular rejection —The pathologic changes that occur with acute cellular rejection
include interstitial infiltration with mononuclear cells and occasionally eosinophils, and
disruption of the tubular basement membranes (tubulitis) by the infiltrating cells.
Acute antibody mediated rejection — Acute antibody mediated rejection (eg, humoral)
rejection, on the other hand, is characterised pathologically by capillary endothelial
swelling, arteriolar fibrinoid necrosis, fibrin thrombi in glomerular capillaries, and frank
cortical necrosis in severe cases.


How would you treat acute rejection in a kidney transplant patient?

Acute rejection is usually treated by giving high dose steroids in the form of three doses of
Methylprednisolone. For more severe cases of rejection it is necessary to administer more
powerful immunosuppression usually with antithymocyte globulin. In general the patient’s
background immunosuppression tablets are also increased.