end stage renal disease Flashcards
where is erythropoietin made?
in the peritubular capillary fibroblasts.
what hormones are deranged in ESKD?
erythropoietin, vitamin D, parathyroid hormone.
characteristics of uremia
loss of appetite (protein), nausea, metallic taste, serositis, pericarditis, mental status changes.
what diets are restricted in ESKD
fluids, sodium, potassium, and phosphate.
what diet is recommended to increase?
protein!
induction to immunosupression agents
given at time of transplant, designed to smack the immune system, but not kill it.
maintenance immunosuppression
designed to keep a long-term light reign on the immune system
agents used for induction are most commonly
antibodies
ATCAM
polyclonal horse serum. pan-t cell suppression for induction.
ALG
thymoglobulin, polyclonal rabbit. used for pan t-cell suppression induction.
OKT3
murine monoclonal that targets CD3 TCR signaling complex. pan t-cell suppression for suppression.
decluzimab
anti-IL-2 receptor. humanized murine monoclonal. targeted t cell for induction.
basilixumab
anti-IL-2 receptor. chimeric murine monoclonal. targeted t cell for induction.
alemtuzimab
humanized anti-CD-52 for induction.
methylprednisilone
standard induction agent. steroid.
what do calcinurin inhibitors target
block IL-2 production. typically started days after the kidney begins working. maintenance
cyclosporin
calcinurin inhibitor.
tacrolimus
calcinurin inhibitor.
azathiopine (imuran)
antimetabolite used for maintenance
mycophenolate mofetil
antimetabolite used for maintenance
mTOR inhibitors
used for maintenance they block cell cycle progression from G1-S. sirolimus everolimus
balatacept
fusion protein of IgG1 Fc and CTLA-4. blocks the costimulation of CD28
how do we stop cell mediated rejection?
pulse steroids and thymoglobulin.
how do we stop antibody rejection?
rituximab, plasmapheresis, IVIG
what are the complications for steroid use?
weight gain, glucose intolerance, hyperlipidemia, hypertension, osteoporosis, avascular necrosis, cataracts.
complications of calcinurin inhibitors
nephrotoxicity, gingival hyperplasia, hypertichosis, hyperlipidemia, tremor, neuropathy, gout
complications for anti-IL-2
HSR
complications of using OKT3, ATCAM, ALG
cytokine release syndrome lymphopenia.
