Kidney Transplant ISS

Question 1

need for one or more hd within 1st week

Answer 1

DGF -FUNCAO TARDIA DO ENXERTO

Question 2

moderate early graft dysfunction, plasma crea > 3 at 1 week post kt

Answer 2

• Allograft function: If a new transplant, is there

immediate graft functioncreat <2,5 dentro de 5 dias

or SGF (Slow graft function) creat >2,5 ate o 5 dia

versus

DGF (Delayed Graft Function, means requiring HD in less than 1 weeks), this is impacted by donor factors, cold ischemia time (>24 hrs), intra-op issues, and patient issues including ischemiareperfusion (warm ischemia time > 45 min).

Question 3

rejection occuring 2-5 days after transplant

Answer 3

Accelerated rejection

Question 4

important risk factor for dgf c

Answer 4

cold ischemia time

fatores de risco =

DOADOR= idade, vivo ou falecido, doador padrao, criterio expandido

RECEPTOR= homem, imc>30, negro, dialise, diabetes, HLA imunizacao

tx=tempo de isquemia quente, tempo de isquemia frio, solucao de armazenamento,maquina de perfusoa ou n

Question 5

high risk patients with rejection symptoms

Answer 5

biopsy day 3-5

Question 6

low risk patients

Answer 6

biopsy day 7-10

Question 7

Tx of acute abmr

Answer 7

pulse, plasmapharesis, ivig, rituximab

Question 8

Mild/moderate tcmr

Answer 8

Steroid pulse

Question 9

Severe tcmr mgt

Answer 9

steroid pulse:thymoglobuling

Question 10

high cni levels

Answer 10

Cyclosporine > 350
tacrolimus > 15

Question 11

common adverse effect of mmf and tacrolimus

Answer 11

diarrhea

Question 12

renal artery or vein thrombosis occurs in the

Answer 12

1st 72h-10 weeks

Question 13

most common cause of allograft function in the first week

Answer 13

acute vascular thrombosis

Question 14

abrupt onset of anuria, rapidly rising crea, negligible graft pain, absent arterial and venous blood flow, MR absent perfusion

Answer 14

renal artery thrombosis

Question 15

anuria pain tenderness swelling hematuria, absent renal venous blood flow and highly abnormal renal arterial waveforms, mr thrombus in the vein

Answer 15

renal vein thrombosis

Question 16

failure of impvt in urine output or plasma crea within 5 days of pulse

Answer 16

steroid resistant tcmr
tx depleting antibodies

Question 17

tcmr resistant to tx witg antilymphocytic antibody

Answer 17

refractory tcell mediated rejection

Question 18

standard target levels of cyclosporine

Answer 18

C0 150-300, 100-200
C2 1400-1700, 800-1299

Question 19

standard level tacrolimus

Answer 19

C0 8-12, 6-9

Question 20

initial measure in transplant tma

Answer 20

switch cni
dc cni, start belatacept or mtor
pex
eculizumab

Question 21

most common microorganism acute pyelo post kt

Answer 21

Gram neg, cons, enterococci

Question 22

most common dryg causing ain

Answer 22

smx tmp

Question 23

best radiologic technique for determining site of obstruction

Answer 23

percutaneous antegrade pyelography

Question 24

Drugs that increase cni level

Answer 24

ccb
antifungal
antidepressant
grapefruit

Question 25

decrease cni level

Answer 25

nafcillin
tb meds
efvires nevirapine
antiseizure meds
st johns

Question 26

plasma viral titers of bk nephropathy

Answer 26

> 10^4

Question 27

tx of bk

Answer 27

discontinue mmf
redcue cni by 30-50

Question 28

chronic active abmr tx

Answer 28

switch to tacro-mmf
target tacro 8
minim mmf
low dose pred
ace/arv

Question 29

striped cortical fibrosis or new onset arteriolar hyalinosis with microcalcification

Answer 29

cni toxicity

Question 30

Gout post kt

Answer 30

cyclosporine
tx colchicine and steroids

Question 31

post kt electrolyte do

Answer 31

hyperCa
hypophos
hyperK
met acid
hypoMg
hyperparathyroid

Question 32

osteoporosis bone density greater than

Answer 32

2.5SD below the mean
osteopenia 1-2.5

Question 33

antihtn agrnts in transplant
chf, post mi, cad

Answer 33

bblocker and ace/arb
no bblocker in htn and proteinuria only

Question 34

high intensity statin recommended for > 21 with

Answer 34

ascvd
ldl > 190
persons 40-75 with dn and est 10 yr risk > 7.5

Question 35

no increased risk ca

Answer 35

breast prostate rectum

Question 36

high sir ca

Answer 36

kaposi with hiv

Question 37

poor prognosis ptld

Answer 37

monoclonal

Question 38

considerations in kt in hiv

Answer 38

cd4 txell > 200
undetectable hiv rna

Question 39

Pregnancy considerations post kt

Answer 39

good health more than 18 mos
stable allograft function
crea less than 2
minimal htn and proteinuria

Question 40

indications for allograft nephrectomy

Answer 40

1. allograft failure symptomatic
2. infarction due to thrombosis
3. severe infection
4. allograft rupture

Question 41

Relative contraindication to donation

Answer 41

2 apol1 renal risk variants
chronic illness
type 2 dm
morbid obesity
active substance use disorder

Question 42

dados importantes sobre o doador

Answer 42

Relevant donor data: age, sex, size, KDPI score, initial/peak/terminal creatinine, HIV/Hep C status urine output, biopsy, relevant history (DM/HTN) Cold and warm ischemia time (preferred cold ischemia time (CIT) is <24 hours and warm ischemia time (WIT) is <45 minutes) Public Health Service (PHS) high risk: yes or no (risk factors include prisoner, history of drug use, sex worker, etc) CMV and EBV status of donor and recipient HLA cross match and if Donor Specific Antibody (DSA) was present Induction therapy Removal of ureteral stent and dialysis catheter (usually to be scheduled post-op so if no date can put to be scheduled) Relevant surgical details if there were intra-operative complications

Question 44

transplante duplo figado e rim

Answer 44

ira por mais de 6 semas com mais um criterio

• dialise
• tfg<25

tfg<60 por mais de 90 dias com : eskd, tfg<30

doenca metabolica