transplants and dialysis

Question 1

forms of RRT?

Answer 1

HD
PD
transplant

Question 2

types of donation

Answer 2

brain stem death
non heart beating
live altruistic donation

Question 3

when do you see survival benefit post transplant

Answer 3

3m

Question 4

what should you assess pre transplant to make sure patient is fit to undergo?

Answer 4

immunology and blood group
virology 
ECG, ECHO, ETT, CXR, PFT
peripheral vessels
mental state 
comorbidity

Question 5

contraindication to transplant

Answer 5

malignancy 
active HIV/HCV
untrwated TB
severe IHD 
severe airway disease
vasculitis 
severe PVD 
hostile bladder

Question 6

live donor transplant assessment

Answer 6

fit?
enough renal function?
anatomically normal?
comorbidity?
immunologically compatible?
psychologically compatiblw?
no coercion?

Question 7

true/false - O donors can receive from anyone

Answer 7

false, they can give to anyone

AB can receive from anyone

Question 8

what HLA matchingf is looked for in transplant

Answer 8

Class I A,B,C

Class II DP, DQ, DR

Question 9

true/false - HLA mismatch will lead to total organ rejection

Answer 9

false - but there is an increased risk graft failure

Question 10

true/false - those who have had transplants before are at increased risk rejection

Answer 10

true - they are sensitised so mismatch of HLA matters more

Question 11

what are the sensitising events that may lead to graft failure

Answer 11

pregnancy
previous transplant
transfusion

Question 12

what is paired donation

Answer 12

when two people need kidneys and there are two seperate donors

Question 13

how can a person be desensitised prior to transplant

Answer 13

plasma exchange

b cell antibody

Question 14

describe the process of a kidney transplant

Answer 14

L/R IF
kidneys left in situ
attached to external iliac artery and vein

Question 15

complications of kidney transplant

Answer 15

bleeding 
artery stenosis 
venous stenosis 
ureteric stricture 
wound infection 
lymphocele

Question 16

how can you identify immediate graft function

Answer 16

decrease in creatinine

good urine output

Question 17

what is primary non function

Answer 17

transplant never worked

Question 18

what is delayed graft funtion

Answer 18

kidney will work in 10-30 days
need HD in interim
need biopsy to find out why

Question 19

what is hyperacute rejection and why does it occur

Answer 19

never event where preformed ab destroy graft on the table

Question 20

how is acute rejection managed

Answer 20

increased immunosuppression

Question 21

true/false - chronic rejection can be managed with increased immunosuppression

Answer 21

false - function will continue to decline and need new transplant

Question 22

induction anti rejection immunosuppression

Answer 22

Pred IV

basilliximab

Question 23

maintenance anti rejection immunosuppression

Answer 23

pred 
tacrolimus 
MMF 
ciclosporin
azathioprine

Question 24

high dose anti rejection immunosuppression

Answer 24

IV methylprednisolone 
ATG
Ig
plassma exchange 
Rituximab

Question 25

what does CMV infection lead to and how is it treated

Answer 25

renal and hepatic dysfunction oesophagitis, PJP, colitis prophylactic gancyclovir and IV gancyclovir

Question 26

what does BK nephropathy represent

Answer 26

over immunosuppression

Question 27

common cancers for transplant?

Answer 27

BCC/SCC | lymphoma

Question 28

causes of graft loss

Answer 28

``` acute rejection death with functioning graft recurrent disease chronic rejection viral nephropathy PTLD ```

Question 29

3 principles of dialyiss

Answer 29

diffusion convection adsorption

Question 30

describe the basic princiole of dialysis

Answer 30

cylinder with hollow filaments had blood passing through it, with ultrapure dialysate in countercurrent to remove toxins

Question 31

describe the use of convection in dialysis

Answer 31

machine creates -ve pressure and causes water ultrafiltration, moving electrolytes and uraemic substances with it

Question 32

describe adsorption and what it principally affecs

Answer 32

plasma proteins | stick to membrane surface and removed by binding

Question 33

what are the benefits to haemodialyfiltration

Answer 33

less symptomatic better survival and recovery time similar cost to HD

Question 34

minimum dialysis time

Answer 34

4hr 3x weekly

Question 35

fluid restiction on dialysis patients?

Answer 35

1L daily if anuric

Question 36

salt restriction on dialysis patients?

Answer 36

no more than 2.3g daily

Question 37

phosphate and K restriction on patients

Answer 37

low PO4 and K diet | phosphate binders with meals

Question 38

pros and cons of tunnelled central vein catheter

Answer 38

pros - immediate and easy to insert | cons - high risk infection, blockage, stenosis and thrombosis of central veins

Question 39

most common organism in central line infection and what can it cause?

Answer 39

staph aureus | endocarditis or discitis

Question 40

treatment of central line infection

Answer 40

vancomycin and gentamicin | line removsal

Question 41

gold standard vascular access for dialysis?

Answer 41

arteriovenous fistula

Question 42

pros and cons of arteriovenous fistula

Answer 42

good blood flow and less risk infection | cons - surgery and needs to mature, steal syndrome, thrombosis and stenosis

Question 43

what is a HeRO graft

Answer 43

graft attached to brachial artery and into venous outflow component good for poor central vein thrombosis or stenosis

Question 44

what can go wrong in dialyiss

Answer 44

``` hypotension myocardial stunning haemorrhage from ruptured AVF arrhythmia cardiac arrest ```

Question 45

describe the process of peritoneal dialysis

Answer 45

catheter in peritoneal cavity under umbilicus | sterile dialysate added and in contact with peritoneum to extract uraemic toxins and then exits by ultrafiltration

Question 46

what are the common organisms for peritonitis secondary to PD

Answer 46

staph, strep, ecoli, klebsiella and diptheroids

Question 47

complications of PD

Answer 47

infection, hernia, peritoneal membrane failure

Question 48

what happens if there is peritoneal membrane failure

Answer 48

need to switch to HD

Question 49

when to start dialysis - bloods?

Answer 49

resistance hyperkalaemia unresonsive metabolic acidosis eGFR <7ml/min urea>40mmol/L

Question 50

when to start dialysis - symptoms?

Answer 50

``` nausea vomiting itch fatigue fluid overload unresponsive to diuretics anorexia ```

Question 51

who wouldnt you dialyse?

Answer 51

patients >75 as they will have similar hospital free days with or without HD

Question 52

medical reasons to discontinue dialysis

Answer 52

``` haemodynamic instability progressive dementia agitation cardiovascular event terminal cancer ```

Question 53

what is disequilibrium syndrome and what causes it

Answer 53

too rapid a correction of uraemic toxins, leading to cerebral oedema, seizure, death, confusion