Dialysis and Transplant

Question 1

threshold for dialysis

Answer 1

eGFR 6-12 mL/min or uremic sx (fatigue, cognitive impairment, volume overload, refractory biochem abnormalities)

Question 2

kidney transplant threshold

Answer 2

can be listed when eGFR less than 20

Question 3

indications for emergent dialysis

Answer 3

uremic pericarditis, pleuritic or uremic encephalopathy

Question 4

preferred dialysis acces

Answer 4

AV fistula, followed by AV graft (veins to weak or small for fistula), then catheter (in neck chest or groin)

Question 5

2 types of peritoneal dialysis

Answer 5

1. continuous ambulatory peritoneal dialysis

2. automated peritoneal dialysis (done at night)

Question 6

location for transplanted kidney

Answer 6

outside peritoneum in iliac fossa

Question 7

transplant advantages over dialysis

Answer 7

lower mortality and morbidity, increased fertility, lower costs

Question 8

contra to transplant

Answer 8

malignancy or high risk of cancer recurrence

active infection

nonadherent to medical regimen

advanced systemic disease

Question 9

most common drugs for transplant immunosuppression

Answer 9

CNIs (tacrolimus/prograf, cyclosporin)

mycophenylate/cellcept
azathiprine

steroids

Question 10

presentations and dx of transplant rejection

Answer 10

either asymptomatic rise in SCr or assoc w/ fever, pain, oliguria, hematuria

dx w/ kidney biopsy

Question 11

list some opportunistic infections after transplant

Answer 11

CMV, EBV, fungi, listeria, nocardia, pneumocystis

Question 12

infection risk in transplant vs dialysis

Answer 12

death from infection 4x less likely w/ transplant than dialysis

Question 13

malignancy risk post transplant

Answer 13

double the risk of avg population- mostly skin cancers or cancers assoc w/ viral infections

Question 14

most common causes of death w/ transplant

Answer 14

most commonly with the graft still functioning, from something like CVD or infection