Kidney Transplant Part 2

Question 1

ample uo and falling crea

Answer 1

excellent graft

Question 2

need for one or more hd within 1st week

Answer 2

DGF

Question 3

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

Answer 3

Sgf

Question 4

rejection occuring 2-5 days after transplant

Answer 4

Accelerated rejection

Question 5

important risk factor for dgf c

Answer 5

cold ischemia time

Question 6

high risk patients with rejection symptoms

Answer 6

biopsy day 3-5

Question 7

low risk patients

Answer 7

biopsy day 7-10

Question 8

Tx of acute abmr

Answer 8

pulse, plasmapharesis, ivig, rituximab

Question 9

Mild/moderate tcmr

Answer 9

Steroid pulse

Question 10

Severe tcmr mgt

Answer 10

steroid pulse:thymoglobuling

Question 11

high cni levels

Answer 11

Cyclosporine > 350

tacrolimus > 15

Question 12

common adverse effect of mmf and tacrolimus

Answer 12

diarrhea

Question 13

renal artery or vein thrombosis occurs in the

Answer 13

1st 72h-10 weeks

Question 14

most common cause of allograft function in the first week

Answer 14

acute vascular thrombosis

Question 15

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

Answer 15

renal artery thrombosis

Question 16

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

Answer 16

renal vein thrombosis

Question 17

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

Answer 17

steroid resistant tcmr

tx depleting antibodies

Question 18

tcmr resistant to tx witg antilymphocytic antibody

Answer 18

refractory tcell mediated rejection

Question 19

standard target levels of cyclosporine

Answer 19

C0 150-300, 100-200

C2 1400-1700, 800-1299

Question 20

standard level tacrolimus

Answer 20

C0 8-12, 6-9

Question 21

initial measure in transplant tma

Answer 21

switch cni
dc cni, start belatacept or mtor
pex
eculizumab

Question 22

most common microorganism acute pyelo post kt

Answer 22

Gram neg, cons, enterococci

Question 23

most common dryg causing ain

Answer 23

smx tmp

Question 24

best radiologic technique for determining site of obstruction

Answer 24

percutaneous antegrade pyelography

Question 25

Drugs that increase cni level

Answer 25

ccb
antifungal
antidepressant
grapefruit

Question 26

decrease cni level

Answer 26

nafcillin 
tb meds 
efvires nevirapine 
antiseizure meds 
st johns

Question 27

plasma viral titers of bk nephropathy

Answer 27

> 10^4

Question 28

tx of bk

Answer 28

discontinue mmf

redcue cni by 30-50

Question 29

chronic active abmr tx

Answer 29

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

Question 30

striped cortical fibrosis or new onset arteriolar hyalinosis with microcalcification

Answer 30

cni toxicity

Question 31

Gout post kt

Answer 31

cyclosporine

tx colchicine and steroids

Question 32

post kt electrolyte do

Answer 32

hyperCa
hypophos 
hyperK
met acid 
hypoMg 
hyperparathyroid

Question 33

osteoporosis bone density greater than

Answer 33

2.5SD below the mean

osteopenia 1-2.5

Question 34

antihtn agrnts in transplant

chf, post mi, cad

Answer 34

bblocker and ace/arb

no bblocker in htn and proteinuria only

Question 35

high intensity statin recommended for > 21 with

Answer 35

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

Question 36

no increased risk ca

Answer 36

breast prostate rectum

Question 37

high sir ca

Answer 37

kaposi with hiv

Question 38

poor prognosis ptld

Answer 38

monoclonal

Question 39

considerations in kt in hiv

Answer 39

cd4 txell > 200

undetectable hiv rna

Question 40

Pregnancy considerations post kt

Answer 40

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

Question 41

indications for allograft nephrectomy

Answer 41

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

Question 42

Relative contraindication to donation

Answer 42

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