Renal Replacement Therapy – Considerations

Indications for Renal Replacement Therapy (notes from TrueLearn)

-broad term : hemodialysis, peritoneal dialysis, hemofiltration, renal transplant
-CRRT is over 24hrs, best for HD unstable patients

Chronic Renal Failure indications
-fluid overload
-uremic symptoms
-ftt
-malnutrition
-GFR criteria

Indications in ICU patient
-oliguria/anuria
-pulmonary edema unresponsive to diuretics
-uncompensated metabolic acidosis (ph35, creatinine >400, hyperkalemia >6.5

Succ will raise K same as normal patient
watch fluid status and hemodynamics
avoid nephrotoxic agents (some a/b, nsaids)

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Renal Tubular Acidosis

From: http://www.anaesthesiamcq.com/AcidBaseBook/ab8_5.php

The table below provides a useful summary of some of the key points in differentiating the types of renal tubular acidosis.

Comparison of Major Types of RTA

 

 Type 1

 Type 2

 Type 4

Hyperchloraemic acidosis

 Yes

 Yes

 Yes

Minimum Urine pH

 >5.5

 <5.5 (but usually >5.5 before the acidosis becomes established)

 <5.5

Plasma potassium 

Low-normal

 Low-normal

 High

Renal stones

 Yes

 No

 No

Defect

Reduced H+excretion in distal tubule

Impaired HCO3reabsorption in proximal tubule

Impaired cation exchange in distal tubule