Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IM Nephrology > 337 Transplantation in Renal Failure > Flashcards

337 Transplantation in Renal Failure Flashcards

1
Q

Treatment of choice for advanced chronic renal failure

A

Transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Expanded Criteria Donor (ECD)

A

Deceased donor >60 years
Deceased donor >50 years, hpn and crea >1.5mg/dl
Deceased donor >50 years, hpn, death by CVA
Deceased donor >50 yrs caused by CVA, crea >1.5mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Donation after Cardiac Death (DCD) I

A

Brought in dead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Donation after Cardiac Death (DCD) II

A

Unsuccessful resucitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Donation after Cardiac Death (DCD) III

A

Awaiting cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Donation after Cardiac Death (DCD) IV

A

Cardiac arrest after brainstem death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Donation after Cardiac Death (DCD) V

A

Cardiac arrest in a hospital patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Deceased-donor grafts have _ % 1 year survival and living donor grafts have _ % 1year survival

A

92%, 96%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Current life expectancy of living-donor graft is _years, deceased donor graft is _ years

A

20 years, 14 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Candidates for renal transplant should have life expectancy of _ years

A

5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Routine screening for transplant patients include:

A

HIV, Hep B C, TB, HIV, Neoplasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ABsolute “immunologic” contraindications for transplantation

A

Presence of antibodies against donor kidneys: ABO, HLA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

True or False.

Rh system is expressed in graft tissue.

A

False.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Direct pathway

A

Class II MHC recognized by CD4 helper cells, CD8 cells recognized -> cytotoxic cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Indirect pathway

A

MHC molecules are transformed into peptides, self APCs, Th cells activated -> secrete cytokines, proliferation of cells, activation of macrophage

Normal physiologic process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Induction therapy

A

antibodies that could be monoclonal or polyclonal; and depletional or nondepletional

17
Q

Maintenance therapy

A

Prednisone, calcineurin inhibitor, antimetabolite; or mTor (can replace the last 2 agents)

18
Q

Belatacept

A

Prevent long term calcineurin inhibitor toxicity, binds to ligands on APCs interrupting binding to CD28 on T cells leading to Tcell anergy and apoptosis

19
Q

Azathioprine

A

analogue of mercaptopurine, inhibit DNA RNA synthesis

20
Q

Mycophenolate mofetil or mycophenolate sodium

A

similar to azathioprine, less side effects

21
Q

Prednisone given as

A

200-300 mg immediately before or at the time of transplant, then reduced to 30mg within a week

22
Q

Methylprednisone for acute rejection given as

A

0.5g to 1g IV immediately on diagnosis then continued once daily for 3 days

Prevents IL 1 and IL 6

23
Q

Cyclosporine

A

Calcineurin inhibitor , inhibits Tcell proliferation

Toxic effects: Nephrotoxicity*, hepatotoxicity, hirsutism, tremor, gingival hyperplasia

24
Q

Tacrolimus / FK506

A

Same as cyclosporine, no hirsutism or gingival hyperplasia

Adverse effect: de novo diabetes mellitus

25
Q

mTOR inhibitors

A

Sirolimus, inhibits Tcell growth factor, preventing IL2 and other cytokines

26
Q

mTOR inbitor

A

Everolimus - better bioavailability

27
Q

Most common clinical evidence of rejection.

A

Increase in serum creatinine with or without reduction in urine volume

RARE : fever, swelling, tenderness on allograft

28
Q

Prophylaxis for CMV and PCP are given when

A

6-12 months after transplantation

29
Q

Peritransplant infections (<1 month)

A

WOund infections
Herpesvirus
Oral candidiasis
UTI

30
Q

Early infections (1-6 months)

A 
PCP
CMV
Legionella
Listeria
Hepatitis B, C
31
Q

Late infections (>6 months)

A 
Aspergillus
Nocardia
BK virus
Herpes zoster
Hep B, C
32
Q

Case: Renal transplant patient unresponsive to all medications, what is the diagnostic of choice?

A

Renal biopsy

33
Q

Renal biopsy shows acute rejection, management?

A

Anti-CD3 monoclonal antibody (OKT3 5g/d x 7-10days)

34
Q

Incidence of tumors in patients on immunosuppressive therapy

A

5-6%

35
Q

Common cancers in immunosuppressed patient

A

skin, cervix, lips, Lymphomas

Surveillance is necessary

36
Q

Target BP for renal transplant patients

A

120-130 /70-80 mmHg

Meds: CCBs more used initially

IM Nephrology (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions