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Flashcards in Urinary: Renal Support Deck (18)
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1
Q

What is the definition of end stage renal failure?

A

When death is likely without renal replacement therapy

eGFR <15ml/min

2
Q

What are the psychological symptoms of end stage renal disease?

A

Tiredness: overwhelming fatigue, physically and mentally exhausted, feel guilty for needing to rest
Difficulty sleeping and concentration
?symptoms dont differ much from depression

3
Q

What are the physical symptoms of end stage renal disease?

A
  • volume overload eg oedema
  • nausea and vomiting
  • restless legs
  • pruritus (intense itching)
  • sexual dysfunction
  • increased infections
4
Q

How does chronic kidney disease affect water and salt handling by the kidney?

A

There is reduced GFR so lose the ability to maximally dilute and concentrate urine

5
Q

What symptoms does accumulation of waste products cause?

A

Reduced appetitie - particularly meat which may be a protective mechanism to prevent nitrogenous waste products
Nausea and vomiting
Contributes to pruritus

6
Q

Why do you need to alter drug doses in someone with CKD/ESRD?

A

There is reduced metabolisms and/or elimination

Drug sensitivity can be increased making side effects more likely eg statins

7
Q

What is the endocrine function of the kidney?

A

Synthesises renin for the RAAS system
Vitamin D metabolism
Synthesis erythropoietin needed for RBC production

8
Q

What are the pros and cons of unit-based haemodialysis?

A

4hrs 3x per week
Advantages: less responsibility, have days off
Disadvantages: travel time, have a set slot which need to stick to, big restriction on fluid and food intake

9
Q

Who is not suitable for haemodialysis?

A
  • if there is no vascular access
  • if they have bad heart failure (have to take 300ml blood out at a time)
  • if they have coagulopathy (a vein has to be attached to artery so is high pressure and can bleed lots)
10
Q

What are some potential complications of haemodialysis?

A

Lines - infection, thrombosis, scarring
CVS instability
Feel chronically unwell

11
Q

What are the 2 types of peritoneal dialysis?

A

CAPD: 4-5 bags throughout the day
APD: overnight dialysis, connect to a machine

12
Q

What are the pros and cons of peritoneal dialysis?

A

Advantages: more independence, less food and fluid restrictions, can travel, better renal preservation initially
Disadvantages: there needs to be frequent 30 min exchanges, you have responsibility for your own care

13
Q

Who is not suitable for peritoneal dialysis?

A
  • if they are obese or have large muscle mass, poor peritoneal area to whole body ratio
  • failure of peritoneal membrane eg too much scarring from previous surgery
  • hernias, stomas
14
Q

What are some potential complications of peritoneal dialysis?

A
  • peritonitis (average of 1 episode every 20 months)
  • tunnel site infections
  • leaks
  • development of herniae
15
Q

What are the pros and cons of renal transplant?

A

Advantages: reduced mortality and morbidity compared to dialysis, better quality of life
Disadvantages: operative risk, malignancy risk, infection, have to take immunosuppressants

16
Q

What are the different types of transplant?

A

Live donor
Deceased after brain death - so organs still perfused
Deceased after circulatory death - so organs not perfused

17
Q

How long does a transplant last?

A

around 11 years

18
Q

What is conservative life care?

A

For those who dont want to have dialysis eg the elderly

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