09.3 Renal replacement therapy

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Questions and Answers

What is the primary mechanism of action for hemodialysis?

Ultrafiltration through a semi-permeable membrane

Active transport of solutes into the dialysate

Capillary filtration under high pressure

Diffusion and osmosis across a semi-permeable membrane (correct)

Which class of drugs is primarily used to prevent graft rejection in transplant patients?

Calcineurin Inhibitors (correct)

Antiplatelet agents

Antibiotics

Corticosteroids

What is a common complication associated with peritoneal dialysis?

Pulmonary embolism

Peritonitis (correct)

Deep vein thrombosis

Hyperkalemia

In the context of chronic kidney disease (CKD), what does initial treatment often focus on?

Lifestyle changes and medications Signup and view all the answers

Which of the following is NOT a common investigation method used for assessing kidney function?

Liver function tests Signup and view all the answers

What is the distinct difference between hemodialysis and peritoneal dialysis?

Peritoneal dialysis uses the peritoneal membrane for filtration Signup and view all the answers

What best characterizes acute kidney injury (AKI)?

Sudden loss of kidney function, often reversible Signup and view all the answers

Which pharmacological class is primarily used for suppressing the immune response in transplant patients?

Corticosteroids Signup and view all the answers

What is the primary focus of hemodialysis in the treatment of End-Stage Renal Disease (ESRD)?

Solute clearance and homeostasis Signup and view all the answers

Which of the following statements is true regarding renal transplantation compared to dialysis?

Renal transplantation restores both renal and endocrine functions. Signup and view all the answers

What are the key considerations for a patient undergoing renal replacement therapy via hemodialysis?

Vascular access, frequency of dialysis sessions, and side effect management Signup and view all the answers

Which of the following is a key symptom indicating the need for renal replacement therapy?

Hyperkalemia Signup and view all the answers

What characterizes peritoneal dialysis compared to hemodialysis?

It utilizes the peritoneal membrane as a filter. Signup and view all the answers

When determining the need for renal replacement therapy (RRT), which eGFR level is considered critical?

Between 5-7 mL/min/1.73 m² Signup and view all the answers

What distinguishes renal transplantation from the other forms of renal replacement therapy?

It fully restores kidney function. Signup and view all the answers

What role does the vascular access play in hemodialysis?

It allows blood to be filtered through a dialyzer. Signup and view all the answers

Study Notes

Renal Replacement Therapy Overview

Renal Replacement Therapy (RRT) replaces kidney function in End-Stage Renal Disease (ESRD) patients.
Methods include hemodialysis, peritoneal dialysis, and renal transplantation.
Dialysis focuses on solute clearance and homeostasis.
Transplantation offers a more complete restoration, including endocrine function.

Learning Objectives

Objective 1: Understand the definition and clinical scope of RRT.
Objective 2: Describe the principles of dialysis.
Objective 3: Differentiate between hemodialysis and peritoneal dialysis.
Objective 4: Explain the advantages and complications of renal transplantation.

Key Concepts

Renal Replacement Therapy (RRT): Medical treatments for ESRD patients.
Hemodialysis: Extracorporeal blood filtering through a dialyzer to remove toxins and correct imbalances.
Peritoneal Dialysis: Intracorporeal dialysis, using the peritoneal membrane as a natural filter.
Renal Transplantation: Surgical kidney replacement for ESRD patients.
End-Stage Renal Disease (ESRD): Chronic kidney disease stage, where kidney function is insufficient without RRT.

Clinical Applications

Case Study: 55-year-old ESRD patient transitioning from peritoneal dialysis to hemodialysis.
Diagnostic Approach: Assessing eGFR (5-7 mL/min/1.73 m²) and symptoms like hyperkalemia, acidosis, or fluid overload.
Treatment Options: Hemodialysis, peritoneal dialysis, and renal transplantation, based on patient needs.
Complications/Management: Sepsis, vascular access failure (hemodialysis), and peritonitis (peritoneal dialysis) require preventive and management strategies.

Pathophysiology

Mechanism: Dialysis works through diffusion and osmosis. Solutes move from higher to lower concentration across a semipermeable membrane.
Hemodialysis: Blood is drawn, filtered through a dialyzer with countercurrent dialysate flow, enhancing solute clearance.
Peritoneal Dialysis: Dialysate is introduced into the peritoneal cavity, using the peritoneal membrane as a filter to remove waste and excess fluid.

Pharmacology (Transplant Patients)

Immunosuppressive Drugs: Calcineurin inhibitors (e.g., Cyclosporine, Tacrolimus), Corticosteroids (e.g., Prednisone), and Antiproliferative Agents (e.g., Mycophenolate Mofetil, Azathioprine).

Differential Diagnosis

Chronic Kidney Disease (CKD): Progressive decline in kidney function, initially managed with lifestyle and medication.
Acute Kidney Injury (AKI): Sudden kidney function loss, often temporary, requiring fluid resuscitation and, when necessary, temporary RRT.
Polycystic Kidney Disease: Genetic disorder causing fluid-filled cysts in kidneys, managed with dialysis or transplantation in severe cases.

Investigations

Blood Tests: Monitor serum creatinine, urea, potassium, bicarbonate, and hemoglobin.
Imaging: Renal ultrasound or CT to evaluate kidney size, structure, and obstructions.
Biopsy: Performed to assess rejection in kidney transplant patients.

Key Diagrams and Visuals

Diagrams illustrate hemodialysis and peritoneal dialysis equipment, highlighting the process.

Summary and Key Takeaways

Three main RRT methods: hemodialysis, peritoneal dialysis, and renal transplantation.
Hemodialysis uses an extracorporeal dialyzer.
Peritoneal dialysis uses the peritoneal membrane.
Transplantation offers most comprehensive kidney function restoration, requiring lifelong immunosuppression.

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Description

This quiz focuses on Renal Replacement Therapy (RRT) for End-Stage Renal Disease (ESRD) patients. You will explore various methods of RRT, including hemodialysis, peritoneal dialysis, and renal transplantation, and examine their principles, advantages, and complications. Test your understanding of these vital kidney replacement methods.