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Prepared by D. Chaplin
Prepared by D. Chaplin
ESRD
Polyuria is perhaps early sign of ESRD As the disease progress unable to rid the body of excess waste products via kidneys uremia results eventually other systems affected When the creatinine clearance falls below 10 ml/min (average), GFR < 5ml/min (average) = dialysis Other symptoms Nocturia, oliguria/anuria, increased K+, Mg++, PO4 and decrease Ca++, Neurological changes, CV changes, etc.
Prepared by D. Chaplin
ESRD or Uremia GFR < 5-10% normal, creatinine clearance <5-10 ml/min
resulting in a cumulative effect
Prepared by D. Chaplin
Treatment Modalities
Decrease fluid 1000ml/day Decrease protein (.5-1kg body weight) Decrease sodium (1-4gm variable)
Decrease potassium
Decrease phosphorous (<1000mg/day) Dialysis (periotoneal, hemodialysis) RBC, Vitamin D (calcitrol replacement) etc.
Prepared by D. Chaplin
Osmosis-Diffusion-Ultrafiltration
Osmosis - movement fluid from an area of < to > concentration of solutes (particles) Diffusion - movement of solutes (particles) from an area of > concentration to area of < concentration [Remove urea, creatinine, uric acid and electrolytes, from the blood to the dialystate bath] RBC, WBC, Large plasma proteins do not go through Ultrafiltration Water and fluid removed when the pressure gradient across the membrane is created, by increase pressure in the blood compartment & decrease pressure in the dialysate compartment
Prepared by D. Chaplin
Peritoneal Dialysis
Catheter placement anterior abdominal wall Tenckoff (25cm length with cuff anchor and migration) Dialysis solution (1-2 liters sometimes smaller) Three phases of PD Inflow (fill) approximately 10 minutes, could be in cycles) Dwell (equilibration) (approximately 20-30 min or 8 hours+) Drain (approximately 15 minutes) These 3 phases are called Exchanges
Prepared by D. Chaplin
Peritoneal Dialysis
Prepared by D. Chaplin
Hemodialysis
Vascular access for high blood flow Shunts, (telfon, external) Arteriovenous fistulas and grafts (AV) Anastomosis between an artery and vein Fistulas are native vessels (4-6 wks maturity) Grafts are artificial/synthetic material
Prepared by D. Chaplin
Hemodialysis
AV Fistula Communication
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AV Graph Access
Hemodialysis
Hemodialysis Circuit
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Hemodialysis Machine
Immediate initiation Less complicated Portable (CAPD) Fewer dietary restrictions Short training time Less cardio stress Choice for diabetics
Prepared by D. Chaplin
Bacterial/chemical periotonitis Protein loss Exit site of catheter Self image Hyperglycemia Surgical placement of catheter Multiple abdominal surgery
Rapid fluid removal Rapid removal of urea & creatinine Effective K+ removal Less protein loss Lower triglycerides Home dialysis possible Temporary access at the bedside
Vascular access problems Dietary & fluid restrictions Heparinization Extensive equipment Hypotension Added blood lost Trained specialist
Prepared by D. Chaplin
Disequalibrium Syndrome
Fluid removal and decrease in BUN during hemodilaysis which cause changes in blood osmolarity.These changes trigger a fluid shift from the vascular compartment into the cells. In the brain, this can cause cerebral edema, resulting in increase intracranial pressure and visible signs of decreasing level of consciousness. Symptoms: Sudden onset of headache, nausea and vomiting, nervousness, muscle twitching, palpitation, disorientation and seizures Treatment: Hypertonic saline, Normal saline
Prepared by D. Chaplin
Renal Transplant
Living and Cadaveric donors
Pre-transplant: Immunotherapy (IV methylprednisolone sodium succinate, (A methaPred, Solu-Medrol), cyclosporine (Sandimmune and azathioprine ((Imuran)
Prepared by D. Chaplin
This gives you your genetic identity (twins share identical HLA)
HLA compatibility minimizes the recognition of the transplanted kidney as foreign tissues.
Prepared by D. Chaplin
Immunological Analysis
WHITE CELL CROSS MATCH (the recipient serum is mixed with donor lymphocytes to test for performed cytotoxic (anti-HLA) antibodies to the potential donor kidney A positive cross match indicates that the recipient has cytotoxic antibodies to the donor and is an absolute contraindication to transplantation
Prepared by D. Chaplin
Immulogical Analysis
MIXED LYMPHOCYTE CULTURE The donor and recipient lymphocytes are mixed. Result = HIGH SENTIVITY, this is contraindicated for renal transplantation.
Surgery
LLQ of the abdomen outside of the peritoneal cavity
Renal artery and vein anastomosed to the corresponding iliac vessels Donor ureters are tunneled into the recipients bladder.
Prepared by D. Chaplin
Signs: increasing serum creatinine, elevated BUN, fever, wt. gain, decrease output, increasing BP, tenderness over the transplanted kidneys
Prepared by D. Chaplin