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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
Q

What types of renal transplant rejections are there

A

Cell mediated

Humoral (Ab mediated)

26
Q

Name cardiovascular complications after renal transplant

A 
o	Underlying renal disease
o	CRF
o	Hypertension
o	Hyperlipidaemia
o	PT Diabetes
27
Q

Name infective complications after a renal transplant

A

o Bacterial
o Viral
o Fungal

28
Q

Name malignant complications after a Renal transplant

A

Skin
Lymphoma
Solid cancers

29
Q

What are the 2 types of acute rejection

A

T cell mediated

Acute antibody mediated

30
Q

What are the classifications within T cell mediated acute rejection

A

Tubulointerstitial (Banff I) Arteritis/endothelialitis (Banff II)
Areterial fibrinoid necrosis (Banff III)

31
Q

What are the classifications of acute antibody mediated rejection

A

ATN-like (Banff I)
Capillaries and or glomerular inflammation (Banff II)
Arterial inflammation (Banff III)

32
Q

What are the features of T cell mediated rejection

A
  • 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
Q

What are the features of antibody mediated rejection

A 
•	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
Q

Name conventional infections that a patient may contract after transplant

A
  • Viral- HSV
  • Bacterial- Wound pneumonia related
  • Hepatitis B
35
Q

Name unconventional infections a patient may contract after a transplant

A
  • Viral- CMV, EBV, VZV, Papova adenovirus
  • Fungal- TB, Penumocystitis
  • CNS- Aspergillus, toxoplasma, cryptococcus]- Listeria
  • Onset of Non-A, Non-B Hepatitis
36
Q

What other infections may a renal transplant patient be at risk from

A

UTI: bacteraemia, pyelitis, relapse

37
Q

What is the most important transplant related infection

A

Cytomegalovirus

38
Q

How is a recipient of a kidney infected with cytomegalovirus

A

o Transmission from donor tissue

o Reactivation of latent virus

39
Q

How can survival of an infection of cytomegalovirus be increased

A

anti-CMV prophylaxis

40
Q

Name the most common types of Polyomaviridae

A

BK
JC
Murine polyoma
SV40

41
Q

What can BK virus cause

A

nephropathy, ureteral stenosis, interstitial nephritis, ESRF

42
Q

What are the risk factors for BK virus associated nephropathy

A

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
Q

What is the outcome of BK virus associated nephropathy

A
  • Allograft dysfunction

* Loss of graft

44
Q

How is BK virus associated nephropathy treated

A
  • Reduce immunosuppression

* Antiviral therapy- Cidofovir, Leflunomide

45
Q

What malignancies are seen in patients after renal transplant

A
  • Colon, lung, breast
  • Testicular, bladder
  • Melanoma, leukaemia, cervical
  • Renal- most common
  • Non-melanoma skin, Kaposi Sarcoma, Non Hodgkins Lymphoma (PTLD)- most common
46
Q

What are the most common malignancies seen after renal transplant

A
  • Renal- most common

* Non-melanoma skin, Kaposi Sarcoma, Non Hodgkins Lymphoma (PTLD)- most common

Urology (26 decks)

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