Dialysis and transplantation Flashcards
Tunneled venous catheters
- high infection risk - mainly what organism?
treatment?
Staph aureus
treatment is usually vancomycin, line removal/exchange
What can result if the patient is drinking too much between sessions?
fluid overload which can cause LVF
What can cause infection in peritoneal dialysis?
peritonitis or exit site infection
contamination - staph, strep, diphtheroids
gut bacteria translocation - e.coli, klebsiella
treatment for infection from peritoneal dialysis
when must the tube be taken out?
intraperitoneal abx
- gram +ve and gram -ve cover (vancomycin and gentamicin)
TAKE OUT TUBE IF THERE IS STAPH AUREUS OR PSEUDOMONAS INFECTION
what can result if you start dialysis too fast?
cerebral oedema
the 3 important HLA types
HLA A
HLA B
HLA DR
how can too much immunosuppression following transplant affect the skin?
non melanoma skin cancer - usually squamous
what infections can too much immunosuppression lead to
pneumocystis jiroveci
BK virus
cytomegalovirus
what do steroids suppress?
activity of T cells and proliferation of B cells
what class of drugs are cyclosporin and tacrolimus
calcineurin inhibitors
side effects of calcineurin inhibitors
renal dysfunction
hypertension
diabetes
tremors
what do azathioprine and mycophenolate block?
S/Es?
purine synthesis
S/Es
- leucopenia, anaemia, GI side effects (toxic colitis, oesophagitis)
what increases azathioprine activity 30-40 x?
allopurinol
V DANGEROUS INTERACTION
can lead to severe leucopenia and aplastic anaemia
absolute contraindications to transplantation
untreated malignancy
untreated TB
severe IHD
severe airways disease
severe PVD (bc we need to transplant onto external iliac artery so it needs to be in good condition)
Active vasculitis - it could recur in the transplant
The live donor assessment
ECG CXR cross matching against potential recipient 24 hr BP monitoring virology renal angiogram
