HEMODIALYSIS

Q. 601. Describe the various component of dialysate fliud?

HEMODIALYSIS

Q. 601. Describe the various component of dialysate fliud? 

A. Reference: Dugridas,  hand book of dialysis 1994:

Dzt component:		Conc.:
	Sodium:				135-155   meq/L
		Potassium:		-       0 - 4        meq/L
		Calcium:		-       1.25 (std)  to 1.75   mmol/L  2.5 (std) to 3.5     meq/L
		Magnesium:		-       0   -   0.75          mmol/L 0- 1.5               meq/L
		Chloride:		-       87- 120            meq/L
		Bicarbonate: (standard)		-       25-40                meq/L
		Glucose:		-       0 (std) to 20  mg/dl

Q. 602. What are the criteria of amyloid cyst?   ……

                                            A.“Amyloid cyst”:

Œ é10 mm. (one cm) size é shoulder & hip.

 é size by 30 % yearly.

Ž Joint space Normal (dcr. in osteoarthritic cyst.).

 Involve more than two joints.

 Multiple (to D.D. fr. Brown tumor of O.F.C., which’s solitary é hip, jaw,& rib.).

-Brown tumor: A fibrous degeneration, cyst formation, and the presence of fibrous nodules in bone, usually due to HYPERPARATHYROIDISM.

Q.603. How to prevent/ttt. amyloid cyst formation?

 A. Prevention of amyloid cyst ] use a biocompatible “Polysulphone”  Dzr.

         - Definitive ttt. ] R.Tx.   👈

Q.604. What is the effect of acidosis on serum K+ level?

A. Every {0.1} P.H. Lower ] 🠞{ 0.7} mmol K+ higher.  ♠

Q.605. Can dialysis patients use Sildenafil (Viagra)?    💘

- Phosphodiasterase inhibitor, Sildenafil (Viagra) cn be used é CrCl <30 mL/ min. é starting dose of 25 mg.

- Viagra  shd NOT be given in three situation:    👌

1)   Nitrate therapy.

2)   Angina pectoris. 

3)   Recent  M.I. (+ve troponin I).

 Q.606. What tumor markers valid in ESRD? What tumor markers  false + ve in ESRD ? What tumor markers false +ve in ESRD?

 

 A. Tumor markers (valid) in ESRD:

1)   a.feto protein.

2)   Total PSA.

3)   C.A. 72

4)   C.A. 125 in non-P.D. ptn.

_ Tumor markers  false +ve in ESRD?

 A.False +ve markers:     ✋

1.    C. A.

2.    G.G.T.

3.    C.A. 125. (in P.D.).

4.    Acidic P.S.A.

5.    C.E.F.

-  AST/ALT   🠞  Normal or low in ESRD.

Q. 607. What are the types of immunoadsorption?

R

 A. Immunoadsorption:      👌

 Protein A coated.

‚ Phenyl alanine coated.

ƒ Anti-human A.B. coated.         

Q.608. What are the indications of plasmapharesis (Pph)?

 A. Indications of Pph: 

 I. Standard Pph:  

1)   Anti-GBM.(Goodpasture's syndrome).

2)   TTP/ HUS.

3)   Mixed cryog. with or without polyneuropathy.

4)   Hyperviscosity syndrome. (waldenstrom).

II. Supportive Pph:

1.    RBGN (crescentic G.N.).

2.    Myeloma kidney.

3.    Post-transfusion purpura.                 

4.    Sickle cell disease. (Cytapharesis).                      

5.    Familial hypercholesterolemia.

III. OTHERS:   

                               i.    Recent FSGS. (post Tx).

                              ii.    A.B.- mediated rejection.

                             iii.    Recent HLA sensitization.

                             iv.    Recurrent N.S.

                              v.    IgA: short term benefit.

                             vi.    Lupus cerebritis.

                            vii.    ANCA- associated Vasculitis.

                          viii.    Thrombocytosis.

                             ix.    i.x. Guian Barre Snd.

                              x.    |M. Gravis.

 

Q.609. In which situations plasmapharesisis is NOT beneficial?  

 A. Pph is NOT beneficial  é:   👌

ΠC.A.N.

 Amyloidosis.

Ž Lupus Nephritis.

Q. 610. Describe the technique of plasmapharesis (Pph)?

 A. Technique of Pph: 

                                I. Filter⮚ Membrane- plasma filter, e.g. cryofilter.

                              II. Separator⮚ Centrifugal cell separator.

Q. 611. What are the side effects of plasmapharesis (Pph)?

 A. “Side effects”of Pph:  ⮚

 Infection.

‚ Access clotting.

ƒ Bleeding tendency.

„ Thrombocytopenia.