KIDNEY TRANSPLANT Flashcards
What is the most common initial clinical presentation of acute rejection in renal allografts?
A. Fever, swelling, and tenderness over the allograft
B. A rise in serum creatinine, with or without reduced urine volume
C. Hypertension and proteinuria
D. Hematuria and severe flank pain
B. A rise in serum creatinine, with or without reduced urine volume
Rationale: Clinical rejection is rarely characterized by fever, swelling, and tenderness over the allograft. Instead, it often presents only with a rise in serum creatinine, sometimes accompanied by reduced urine volume. Early detection through laboratory tests is crucial for preventing irreversible damage.
What is the gold standard for diagnosing acute T cell–mediated and antibody-mediated rejection in renal transplantation?
A. Serum creatinine levels
B. Doppler ultrasonography
C. Allograft biopsy
D. Noninvasive biomarkers
C. Allograft biopsy
Rationale: While Doppler ultrasonography and noninvasive biomarkers can aid in the diagnostic process, allograft biopsy remains the gold standard for diagnosing acute rejection, as it provides definitive evidence of immune cell infiltration (T cell–mediated rejection) or endothelial injury and complement deposition (antibody-mediated rejection).
Which diagnostic tool is most useful in identifying renal vascular thrombosis or urinary obstruction in a kidney transplant recipient?
A. Noninvasive biomarkers
B. Diagnostic ultrasound
C. Serum creatinine measurements
D. Banff classification
B. Diagnostic ultrasound
Rationale: Diagnostic ultrasound, including Doppler ultrasonography, is valuable for evaluating renal vasculature changes and renal blood flow, and for identifying complications such as renal vein thrombosis or urinary obstruction (e.g., urinoma, hematoma, or lymphocele).
What is the initial treatment for acute T cell–mediated rejection in renal transplant recipients?
A. Plasmapheresis and IVIG
B. High-dose corticosteroids (e.g., IV methylprednisolone)
C. Rituximab and bortezomib
D. Calcineurin inhibitor dose adjustment
B. High-dose corticosteroids (e.g., IV methylprednisolone)
Rationale: The first-line treatment for acute T cell–mediated rejection involves high-dose corticosteroids, such as IV methylprednisolone (500–1000 mg daily for 3 days). If there is no response, antibody therapy (e.g., ATG) is considered.
Which noninvasive biomarker is used as an adjunct for the diagnosis of renal allograft rejection?
A. Serum creatinine
B. CXCL9 urine chemokine marker
C. Hemoglobin levels
D. C4d complement deposition
B. CXCL9 urine chemokine marker
Rationale: Circulating donor-derived cell-free DNA and urine chemokine markers such as CXCL9 have recently been employed as noninvasive adjunct diagnostic markers for rejection. They can support clinical decision-making but are not yet definitive diagnostic tools.
What is the leading cause of death in kidney transplant recipients?
A. Infection
B. Malignancy
C. Cardiovascular events
D. Rejection
C. Cardiovascular events
Rationale: Cardiovascular events account for the highest percentage of mortality in kidney transplant recipients (29%), followed by infection (18%) and malignancy (17%). These factors underscore the importance of cardiovascular risk management in transplant care.
What is the first-line treatment for Pneumocystis jirovecii pneumonia (PJP) in kidney transplant recipients?
A. Fluconazole
B. Trimethoprim-sulfamethoxazole (TMP-SMX)
C. Amphotericin B
D. Valganciclovir
B. Trimethoprim-sulfamethoxazole (TMP-SMX)
Rationale: TMP-SMX is the treatment of choice for Pneumocystis jirovecii infections. Prophylactic low-dose TMP-SMX for six months post-transplant effectively reduces the risk of PJP. Amphotericin B is reserved for systemic fungal infections.
Which kidney transplant recipients are at the highest risk for cytomegalovirus (CMV) infection?
A. Seropositive recipients of seronegative donors
B. Seronegative recipients of seropositive donors
C. Recipients with low plasma viral load
D. Recipients on TMP-SMX prophylaxis
B. Seronegative recipients of seropositive donors
Rationale: CMV infection is most likely to occur in seronegative recipients of seropositive donors due to the lack of preexisting immunity. Regular monitoring of plasma viral load and prophylaxis with valganciclovir are critical in this population.
What is the main approach to managing BK virus reactivation in kidney transplant recipients?
A. Initiation of fluconazole therapy
B. Aggressive immunosuppression
C. Reduction of immunosuppression
D. Immediate initiation of leflunomide
C. Reduction of immunosuppression
Rationale: BK virus reactivation is strongly associated with the degree of immunosuppression. The primary approach involves reducing maintenance immunosuppression to control the infection and prevent graft loss. Additional therapies, such as leflunomide or IVIG, are used in refractory cases.
What diagnostic finding confirms CMV infection in a kidney transplant recipient?
A. Detection of BK virus DNA in blood
B. Positive culture for Candida in the oropharynx
C. Plasma viral load and a rise in IgM antibodies to CMV
D. Imaging findings consistent with nephritis
C. Plasma viral load and a rise in IgM antibodies to CMV
Rationale: CMV infection is diagnosed based on elevated plasma viral load and IgM antibodies. Clinical manifestations may vary from asymptomatic viremia to systemic syndrome or tissue-specific complications such as hepatitis or gastroenteritis.
Which opportunistic infection may necessitate transbronchial or open-lung biopsy for diagnosis in transplant recipients?
A. BK virus nephropathy
B. Pneumocystis jirovecii pneumonia (PJP)
C. Cytomegalovirus (CMV) infection
D. Candida oropharyngeal involvement
B. Pneumocystis jirovecii pneumonia (PJP)
Rationale: Pneumocystis jirovecii pneumonia may require aggressive diagnostic measures such as transbronchial or open-lung biopsy when noninvasive methods are inconclusive, given the critical nature of this opportunistic infection in immunosuppressed patients.
Which of the following infections is most commonly observed in the peritransplant period (<1 month)?
A. Cytomegalovirus
B. Oral candidiasis
C. BK virus
D. Aspergillus
B. Oral candidiasis
Rationale: During the peritransplant period, common infections include wound infections, herpesvirus, oral candidiasis, and urinary tract infections due to surgical and early immunosuppressive effects.
What is the most common time frame for Pneumocystis carinii infection after kidney transplantation?
A. Peritransplant (<1 month)
B. Early (1–6 months)
C. Late (>6 months)
D. Anytime post-transplant
B. Early (1–6 months)
Rationale: Opportunistic infections like Pneumocystis carinii and cytomegalovirus typically occur within the first 1–6 months, when immunosuppression is at its peak.
Which infection is commonly associated with the late post-transplant period (>6 months)?
A. Legionella
B. BK virus (polyoma)
C. Hepatitis C
D. Wound infections
B. BK virus (polyoma)
Rationale: Late post-transplant infections, such as BK virus, Aspergillus, and Nocardia, often occur when chronic immunosuppression leads to increased susceptibility to opportunistic infections.
Which of the following infections can occur during both the early and late post-transplant periods?
A. Cytomegalovirus
B. Herpes zoster
C. Hepatitis B
D. Listeria
C. Hepatitis B
Rationale: Hepatitis B and C can occur in both early and late post-transplant periods, as they may result from reactivation of latent infections or new exposures.
