Kidney Transplant Part 2 Flashcards
ample uo and falling crea
excellent graft
need for one or more hd within 1st week
DGF
moderate early graft dysfunction, plasma crea > 3 at 1 week post kt
Sgf
rejection occuring 2-5 days after transplant
Accelerated rejection
important risk factor for dgf c
cold ischemia time
high risk patients with rejection symptoms
biopsy day 3-5
low risk patients
biopsy day 7-10
Tx of acute abmr
pulse, plasmapharesis, ivig, rituximab
Mild/moderate tcmr
Steroid pulse
Severe tcmr mgt
steroid pulse:thymoglobuling
high cni levels
Cyclosporine > 350
tacrolimus > 15
common adverse effect of mmf and tacrolimus
diarrhea
renal artery or vein thrombosis occurs in the
1st 72h-10 weeks
most common cause of allograft function in the first week
acute vascular thrombosis
abrupt onset of anuria, rapidly rising crea, negligible graft pain, absent arterial and venous blood flow, MR absent perfusion
renal artery thrombosis
anuria pain tenderness swelling hematuria, absent renal venous blood flow and highly abnormal renal arterial waveforms, mr thrombus in the vein
renal vein thrombosis
failure of impvt in urine output or plasma crea within 5 days of pulse
steroid resistant tcmr
tx depleting antibodies
tcmr resistant to tx witg antilymphocytic antibody
refractory tcell mediated rejection
standard target levels of cyclosporine
C0 150-300, 100-200
C2 1400-1700, 800-1299
standard level tacrolimus
C0 8-12, 6-9
initial measure in transplant tma
switch cni
dc cni, start belatacept or mtor
pex
eculizumab
most common microorganism acute pyelo post kt
Gram neg, cons, enterococci
most common dryg causing ain
smx tmp
best radiologic technique for determining site of obstruction
percutaneous antegrade pyelography
Drugs that increase cni level
ccb
antifungal
antidepressant
grapefruit
decrease cni level
nafcillin tb meds efvires nevirapine antiseizure meds st johns
plasma viral titers of bk nephropathy
> 10^4
tx of bk
discontinue mmf
redcue cni by 30-50
chronic active abmr tx
switch to tacro-mmf target tacro 8 minim mmf low dose pred ace/arv
striped cortical fibrosis or new onset arteriolar hyalinosis with microcalcification
cni toxicity
Gout post kt
cyclosporine
tx colchicine and steroids
post kt electrolyte do
hyperCa hypophos hyperK met acid hypoMg hyperparathyroid
osteoporosis bone density greater than
2.5SD below the mean
osteopenia 1-2.5
antihtn agrnts in transplant
chf, post mi, cad
bblocker and ace/arb
no bblocker in htn and proteinuria only
high intensity statin recommended for > 21 with
ascvd
ldl > 190
persons 40-75 with dn and est 10 yr risk > 7.5
no increased risk ca
breast prostate rectum
high sir ca
kaposi with hiv
poor prognosis ptld
monoclonal
considerations in kt in hiv
cd4 txell > 200
undetectable hiv rna
Pregnancy considerations post kt
good health more than 18 mos
stable allograft function
crea less than 2
minimal htn and proteinuria
indications for allograft nephrectomy
- allograft failure symptomatic
- infarction due to thrombosis
- severe infection
- allograft rupture
Relative contraindication to donation
2 apol1 renal risk variants chronic illness type 2 dm morbid obesity active substance use disorder
