MRCP revision battle 45.1: Dialysis and complications
MRCP revision battle 45.2: Anaemia in chronic renal failure
MRCP revision battle 45.3: Diuretics
MRCP revision battle 45.4: Proteinuria
MRCP revision battle 45.5: Renal osteodystrophy
MRCP revision battle 45.6: Radio-contrast nephropathy
MRCP revision battle 45.7: Minimal change disease
MRCP revision battle 45.1: Dialysis and complications
Lets start with a very matter-of-fact battle on dialysis and its complications
Brief overview of types of renal replacement therapy
- Haemodialysis
- semi-permeable membrane
- solute transfer by diffusion
- excess fluid removed by creating a negative transmembrane pressure = ultrafiltration
- Haemofiltration
- highly permeable membrane
- solute transfer by convection
- ultrafiltrate replaced by an equal volume of substitute fluid
- takes longer and is more expensive than haemodialysis but less haemodynamic instability so used for critically ill patients
- Peritoneal dialysis
- dialysis fluid put into abdominal cavity via tenchkoff catheter
- solutes diffuse across peritoneal membrane
- ultrafiltration achieved by adding glucose to the dialysis fluid
Complications of dialysis
- Disequilibration syndrome
- occurs on initial dialysis
- manifests as nausea, vomiting, headache and altered consciousness
- caused by rapid changes in plasma osmolality
- Vascular disease
- Heart valve calcification - especially aortic valve
- Beta-2 microglobulin amyloidosis
- Arthritis
- Infections
Now to consider anaemia in renal failure...
