Term
| What are the 4 primary causes of ESRD requiring hemodialysis/transplant? |
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Definition
1) DM
2) HTN
3) Glomerulonephritis
4) Cystic kidney diseases |
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Term
| What are the 5 indications for Dialysis/renal replacement therapy? |
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Definition
AEIOU!
A) Acidosis that is resistant to treatment.
E) Electrolyte abnormalities like hyperkalemia with EKG changes.
I) Intoxications with water soluble drugs
O) Overload with salt/water refractory to diuretics causing pulmonary edema, CHF and HTN.
U) Uremic symptoms like pericarditis, uremic bleeding, intractable nausea and vomiting, anorexia. |
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Term
| What are the 3 primary goals of renal replacement therapy? |
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Definition
Uremic waste removal, mineral maintenance and volume management.
1) Remove uremic waste products and correct secondary effects
2) Replenish calcium and bicarbonate stores
3) Remove excess water and salt |
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Term
| How does Hemodialysis work? |
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Definition
Includes 4 elements
- Vascular access (make an AV fistula)
- Dialysis filter (determines pore size for high MW)
- Dialysis solution
- Dialysis machine (determines flow rate for low MW)
- Blood and diasylate flow in opposite directions (countercurrent)
1) Removal of solute occurs by Diffusion
** low MW passage depends on flow rate and high MW depends on pore size**
2) Removal of solvent by Ultrafiltration
- hydrostatic pressure gradient drives water movement (solutes are dragged along)
3) Access
- If emergent, use temporary catheter in IJV.
- Create AV Fistula- Natural or Synthetic (more infection, clots and shorter lives)
- If fistula not possible, and you need >2-3 weeks, you can use tunneled dialysis catheter |
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Term
| What are 4 major access complications in hemodialysis? |
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Definition
AV fistula problems
1) Thrombosis- outflow obstruction
2) Infection- local of infective emboli
3) Steal syndrome- reduce BF to hand, distal to anastamosis
4) Cardiac overload- 10% increase in CO |
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Term
| What are acute/chronic major complications of Hemodialysis? |
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Definition
Acute (Hypotension, cramps, nausea/vomiting)
1) Hypotension- excessive ultrafiltration or peripheral vasodilation (give hypertonic saline or mannitol).
2) Cramps- from hypotension or low diasylate sodium (saline or muscle relaxant)
3) Nausea and Vomiting (hypotension or disequilibrium syndrome (too brisk reduction in uremic waste)
Chronic (develop due to CKD and continue after dialysis)
1) Malnutrition (look at serum albumin)
2) Hypertension
3) Hyperlipidemia
4) Pruruitis
5) Mortality |
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Term
| How does Peritoneal Dialysis work? |
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Definition
1) Peritoneal membrane used as dialyzing membrane and fluid is instilled in abdomen, left for a period of time, and drained (4-5 times a day)
2) Fluid and solute exchange occurs between capillary blood and dialysis solution in peritoneal cavity, and solutes are again removed by Diffusion.
**affected by disease states (peritonitis)
3) Water removal again via ultrafiltration (with solvent drag)
- Can increase glucose in diasylate solution to increase osmotic gradient and water flow across membrane. |
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Term
Why might you choose Peritoneal dialysis over Hemodialysis?
What might be the limitations? |
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Definition
Advantages of Peritoneal Dialysis
1) few hemodynamic effects (good for unstable cardiac)
2) Quality of life and freedom
3) No disequilibrium syndromes
4) Diet is easier
5) Medication access (insulin and antibiotics)
Disadvantages
1) Less efficient (especially in larger folks)
2) INFECTION
3) compliance
4) Can't be used with peritoneal disease |
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Term
| What is the difference between Continuous Ambulatory PD and Continuous Cycler PD (advantages and disadvantages)? |
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Definition
1) CAPD (2L diasylate with 4-8h dwell time
- GOOD: involves long dwell time, with larger solute clearance
- BAD: Manual exchanges is infection risk
2) CCPD (automatic cycler at bedtime- 3-5h dwell time)
- GOOD: convenience and less infection
- BAD: short dwell time may limit clearance |
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Term
| What are the major complications associated with Peritoneal Dialysis? |
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Definition
1) Mechanical
- cath occlusion with fibrin (heparin)
- cath occlusion with poppo (laxative)
- cath malposition.
2) Diasylate leaks
- Pleural effusions through diaphragm
- Sub-q leak |
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Term
| How does Renal Transplant surgery work? |
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Definition
Better outcome than dialysis!
**referred when GFR <20 ml/min
1) 3-4 hour operation involving anastamoses to common, external or internal iliac artery and vein and ureter connected to bladder.
2) 5 day hospitalization |
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Term
True or False:
Deceased donor kidneys are associated with higher mortality than living donations. |
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Definition
True!
Only slight difference. Major issue is DONATION. |
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Term
| What immunosuppressive agents are kidney transplant patients placed on? |
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Definition
1) Corticosteroids
- Prevent IL-1 and IL-6 production by macrophages
2) Calcineurin inhibitors (Cyclosporine A and tacrolimus)
- Block IL-2 release from T-cells and prevent type IV reaction.
3) Azothioprine- converts to 6-meraptopurine and inhibits DNA/RNA synthesis (decrease lymphocyte production)
4) Mycophenolate- inhibits IMPDH (purine metabolism) and decreases B/T lymphocyte production.
5) Sirolimus- Inhibits T-cell activation by supressing IL-2 and IL-4 mediated proliferation (also inhibits B cells)
6) Belatacept- co-sitmulatory blockage. |
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Term
| How are patients evaluated for possible renal transplant? |
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Definition
1) Cardiac Health- stress test/EKG
2) Malignancy screening
3) ID
4) HLA-typing
5) Social issues (adherence ect.)
6) 2-5 year wait after 1-5 |
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Term
| What is the leading cause of post-transplant death? |
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Definition
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