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Urology > Lecture 16 Renal Replacement Therapy 2 (Transplantation) > Flashcards

Lecture 16 Renal Replacement Therapy 2 (Transplantation) Flashcards

1
Q

Transplanted kidneys are placed where and what vascular system are they attached to

A

Iliac fossa

Iliac vessels

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2
Q

What happens to the diseased kidneys after a renal transplant

A

Remain in situ

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3
Q

What indications are there for a native kidney to undergo nephrectomy

A

Increase in size- polycystic

Infection- chronic pyelonephritis

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4
Q

What is the timeline of a kidney once it is is removed for transplantation

A 
•	Preservation of donor kidney
o	Cold preservation solutions
o	Continuous pulsatile hypothermic machine perfusion
o	Minimize oedema
o	Preserve integrity of tissues
o	Buffer free radicals
•	Transplantation
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5
Q

What are the vascular complications of kidney transplant

A 
•	Bleeding
–	Usually anastomotic sites
–	Perirenal haematoma can be arterial or venous
•	Arterial thrombosis
•	Venous thrombosis
•	Lymphocele
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6
Q

Name a ureteric complication of a kidney transplant

A

Urine leak

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7
Q

Name another complication of a kidney transplant

A

Infection

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8
Q

Name types of immunosuppressive agents

A 
Corticosteroids
Calcineurin inhibitors
Anti-proliferatives
mTOR inhibitors
Costimulatory signal blockers
Depleting agents
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9
Q

What type of immunosuppressive agent is Tacrolimus, Cyclosporine

A

Calcineurin inhibitors

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10
Q

What type of immunosuppressive ageists are Mycophenolate mofetil, Azathioprine

A

Anti-proliferatives

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11
Q

What type of immunosuppressants is Sirolimus

A

mTOR inhibitors

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12
Q

What type of immunosuppressant is Belatacept

A

Costimulatory signal blocker

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13
Q

Wha type of immunosuppressant is Basiliximab ( anti-CD25), Anti-thymocyte globulin (ATG), Rituximab (anti-CD20)

A

Depleting agents

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14
Q

What are the side effects of corticosteroids

A

Hypertension, hyperglycemia, infections, bone loss, GI bleeding

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15
Q

What are the side effects of Tacrolimus

A

Hyperglycemia, AKI, tremor

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16
Q

What are the side effects of cyclosporin

A

Hirsuitism, hypertension, AKI, gout

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17
Q

What are the side effects of Mycophenolate mofetil

A

Cytopenia, GI upset

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18
Q

What are the side effects of Sirolimus

A

Lipidogenic, diabetogenic, pneumonia

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19
Q

What are the side effects of Belatacept

A

Infections, malignancy

20
Q

What are the side effects of ATG

A

Infections, PTLD

21
Q

Describe the immunosuppression protocol

A
  1. Induction-Depleting agent

2. Maintenance- Anti-prof, Calcineurin inhibitor, steroid

22
Q

Name the 2 types of donors

A

Deceased- donation after brain death/cardiac death

Living donor: relative, spouse, altruistic, paired/pooled

23
Q

What s the brain death criteria

A
  • Coma, unresponsive to stimuli
  • Apnoea off ventilator (with oxygenation) despite build up of CO2
  • Absence of cephalic reflexes
  • Body temperature above 34 C
  • Absence of drug intoxication
24
Q

What is the expanded criteria donors

A

– Donor aged > 60y

– Donor aged 50-59 + history of hypertension, death from cerbrovascular accident or terminal creatinine of >132µmol/L

25
What types of renal transplant rejections are there
Cell mediated | Humoral (Ab mediated)
26
Name cardiovascular complications after renal transplant
``` o Underlying renal disease o CRF o Hypertension o Hyperlipidaemia o PT Diabetes ```
27
Name infective complications after a renal transplant
o Bacterial o Viral o Fungal
28
Name malignant complications after a Renal transplant
Skin Lymphoma Solid cancers
29
What are the 2 types of acute rejection
T cell mediated | Acute antibody mediated
30
What are the classifications within T cell mediated acute rejection
Tubulointerstitial (Banff I) Arteritis/endothelialitis (Banff II) Areterial fibrinoid necrosis (Banff III)
31
What are the classifications of acute antibody mediated rejection
ATN-like (Banff I) Capillaries and or glomerular inflammation (Banff II) Arterial inflammation (Banff III)
32
What are the features of T cell mediated rejection
* Lymphocytic infiltrate * Tubulitis- presence of inflammatory cells in the tubular wall * Endarteritis- inflammation of the inner lining of an artery. * Endothelialitis- inflammation of the endothelium
33
What are the features of antibody mediated rejection
``` • Microvascular inflammation o Neutrophil infiltration o Glomeruli o Peritubular capillaries • Donor specific antibodies • Positive C4d o peritubular capillaries ``` New Onset Diabetes Mellitus after Transplantation
34
Name conventional infections that a patient may contract after transplant
* Viral- HSV * Bacterial- Wound pneumonia related * Hepatitis B
35
Name unconventional infections a patient may contract after a transplant
* Viral- CMV, EBV, VZV, Papova adenovirus * Fungal- TB, Penumocystitis * CNS- Aspergillus, toxoplasma, cryptococcus]- Listeria * Onset of Non-A, Non-B Hepatitis
36
What other infections may a renal transplant patient be at risk from
UTI: bacteraemia, pyelitis, relapse
37
What is the most important transplant related infection
Cytomegalovirus
38
How is a recipient of a kidney infected with cytomegalovirus
o Transmission from donor tissue | o Reactivation of latent virus
39
How can survival of an infection of cytomegalovirus be increased
anti-CMV prophylaxis
40
Name the most common types of Polyomaviridae
BK JC Murine polyoma SV40
41
What can BK virus cause
nephropathy, ureteral stenosis, interstitial nephritis, ESRF
42
What are the risk factors for BK virus associated nephropathy
Intensity of immunusuppresion - older age, male gender, white ethnicity, DM, negative BKV serostatus (paediatric recipients) Graft injury, HLA mismatch, ureteral stents - changes in epitopes of viral capsid protein VP-1
43
What is the outcome of BK virus associated nephropathy
* Allograft dysfunction | * Loss of graft
44
How is BK virus associated nephropathy treated
* Reduce immunosuppression | * Antiviral therapy- Cidofovir, Leflunomide
45
What malignancies are seen in patients after renal transplant
* Colon, lung, breast * Testicular, bladder * Melanoma, leukaemia, cervical * Renal- most common * Non-melanoma skin, Kaposi Sarcoma, Non Hodgkins Lymphoma (PTLD)- most common
46
What are the most common malignancies seen after renal transplant
* Renal- most common | * Non-melanoma skin, Kaposi Sarcoma, Non Hodgkins Lymphoma (PTLD)- most common

Urology (26 decks)

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