end stage renal disease

Question 1

where is erythropoietin made?

Answer 1

in the peritubular capillary fibroblasts.

Question 2

what hormones are deranged in ESKD?

Answer 2

erythropoietin, vitamin D, parathyroid hormone.

Question 3

characteristics of uremia

Answer 3

loss of appetite (protein), nausea, metallic taste, serositis, pericarditis, mental status changes.

Question 4

what diets are restricted in ESKD

Answer 4

fluids, sodium, potassium, and phosphate.

Question 5

what diet is recommended to increase?

Answer 5

protein!

Question 6

induction to immunosupression agents

Answer 6

given at time of transplant, designed to smack the immune system, but not kill it.

Question 7

maintenance immunosuppression

Answer 7

designed to keep a long-term light reign on the immune system

Question 8

agents used for induction are most commonly

Answer 8

antibodies

Question 9

ATCAM

Answer 9

polyclonal horse serum. pan-t cell suppression for induction.

Question 10

ALG

Answer 10

thymoglobulin, polyclonal rabbit. used for pan t-cell suppression induction.

Question 11

OKT3

Answer 11

murine monoclonal that targets CD3 TCR signaling complex. pan t-cell suppression for suppression.

Question 12

decluzimab

Answer 12

anti-IL-2 receptor. humanized murine monoclonal. targeted t cell for induction.

Question 13

basilixumab

Answer 13

anti-IL-2 receptor. chimeric murine monoclonal. targeted t cell for induction.

Question 14

alemtuzimab

Answer 14

humanized anti-CD-52 for induction.

Question 15

methylprednisilone

Answer 15

standard induction agent. steroid.

Question 16

what do calcinurin inhibitors target

Answer 16

block IL-2 production. typically started days after the kidney begins working. maintenance

Question 17

cyclosporin

Answer 17

calcinurin inhibitor.

Question 18

tacrolimus

Answer 18

calcinurin inhibitor.

Question 19

azathiopine (imuran)

Answer 19

antimetabolite used for maintenance

Question 20

mycophenolate mofetil

Answer 20

antimetabolite used for maintenance

Question 21

mTOR inhibitors

Answer 21

used for maintenance they block cell cycle progression from G1-S. sirolimus everolimus

Question 22

balatacept

Answer 22

fusion protein of IgG1 Fc and CTLA-4. blocks the costimulation of CD28

Question 23

how do we stop cell mediated rejection?

Answer 23

pulse steroids and thymoglobulin.

Question 24

how do we stop antibody rejection?

Answer 24

rituximab, plasmapheresis, IVIG

Question 25

what are the complications for steroid use?

Answer 25

weight gain, glucose intolerance, hyperlipidemia, hypertension, osteoporosis, avascular necrosis, cataracts.

Question 26

complications of calcinurin inhibitors

Answer 26

nephrotoxicity, gingival hyperplasia, hypertichosis, hyperlipidemia, tremor, neuropathy, gout

Question 27

complications for anti-IL-2

Answer 27

HSR

Question 28

complications of using OKT3, ATCAM, ALG

Answer 28

cytokine release syndrome lymphopenia.