Nephrology,transplant

Question 1

DDAVP in reducing blood loss in ESRF patients:
Dose = ?
Mechanism =?

Answer 1

0.3ug / kg

Stimulates release of vWF

Question 2

Normal decline of GFR : __

Answer 2

5 every decade

Question 3

A gene causing CKD in Africans

Answer 3

APOL1 gene

Question 4

Annual death rate in transplanted vs. in dialysis patients awaiting transplant = ?

Answer 4

3.8 vs 6.3 per 100 patient-years

Question 5

Genes encoding these are located on ch = ?
HLA
B2m

Answer 5

HLA : Ch6

B2m : Ch15

Question 6

what is death?

Answer 6

irreversible
resp + circu
entire brain

Question 7

what classification is used for donation after circulatory death (DCD)?

Answer 7

Maastricht classification
1 - 2 uncontrolled
3 - 4 controlled

Question 8

what is 10-y graft survival for living and cadaveric RT?

Answer 8

living 81%

cadaveric 70%

Question 9

what is the Amsterdam forum consensus on kidney donation?

Answer 9

regarding stone
not young
single , small < 1.5cm
not infected, metabolically normal

Question 10

what UK committee advises on the risk of transmitting cancer through transplantation?

Answer 10

SaBTO

Advisory committee on Safety of Blood, Tissues and Organs

Question 11

what is the risk of transmission of a cancer from a donor not previously known to have cancer ?

Answer 11

0.05%

Question 12

Give examples of minimal risk of transmitting cancer through transplantation from a donor.
Bladder
Kidney
Prostate

Answer 12

< 0.1%
Bladder: superficial noninvasive
Kidney: resected solitary < 1cm LG RCC
Prostate: curative treatment, GG1 , cancer free > 5y

Question 13

definition of extended criteria donors

Answer 13

> 60y,

> 50y with HT, elevated Cr, death due to CVD

Question 14

risk of pre-eclampsia to donor =?

Answer 14

5% -> 11%

Question 15

estimated lifetime risk of ESRD to donors = ?

Answer 15

0.14 -> 0.9%

Question 16

Mortality risk to donor nephrectomy

Answer 16

0.01%

Question 17

mechanism of ischemic - reperfusion injury

Answer 17

depletion of ATP
water influx, cellular edema
tubular cellular edema, necrotic debris -> tubular obstruction
reperfusion - hypoxanthine oxidised to xanthine + free radicals

Question 18

HTK solution and physiology?

Answer 18

Histidine: buffer
Tryptophan: free radical scavenger
ketoglutarate: substrate for aerobic

Question 19

what is hypothermic pulsatile machine perfusion?

why the controversy?

Answer 19

dynamic flow of cold perfusate, monitoring of perfusion parameters
? better DGF, 3y graft survival (ECD)
? cost, technical errors, ? no benefit in DCD

Question 20

Active malignancy in the potential recipient is contraindication to receiving transplantion, except = ?

Answer 20

superficial nonmelanoma
incidental renal tumors <= 1cm
prostate GG1

Question 21

types of cross-match techniques?

Answer 21

physical: CDC, FCXM
virtual: solid phase tests

Question 22

what is panel-reactive antibody PRA?

what is calculated PRA?

Answer 22

% of donors that + ve XM

% of donors with at least 1 unacceptable HLA-antigen

Question 23

USG findings of renal vein thrombosis

Answer 23

spiked systolic flow
reverse diastolic flow
absent venous flow

Question 24

what is Hilson perfusion index?

Answer 24

AUC of iliac / graft artery

Normal < 150

Question 25

Transplant RAS

USG findings = ?

Answer 25

PSV > 200cm/s

Turbulent flow, parvus tardus

Question 26

mechanism of steroid in immunosuppression

Answer 26

inhibits transcription of cytokine genes

NF-kB’s translocation to nucleus, SRC, GRE

Question 27

Calcineurin inhibitors
mechanism
metabolism by

Answer 27

inhibits calcineurin, unable to deP NFAT, cannot translocate

CYP3A

Question 28

purine synthesis inhibitors (AZA, MMF)

mechanism

Answer 28

AZA: purine analogue

MMF IMPDH inhibitor

Question 29

Immunosuppression

Cannot use ___ in pregnancy

Answer 29

MMF (teratogenic)

Question 30

Name 2 cautions in using AZA

Answer 30

XO inhibitors
TPMT level
(metabolism)

Question 31

what is anti-thymocyte globulin ATG?

Answer 31

polyclonal Ab

induce T cell apoptosis

Question 32

what is basiliximab

Answer 32

monoclonal Ab
CD25 of IL-2 receptors
T cells

Question 33

what is alemtuzumab

Answer 33

mAb against CD 52

T cells

Question 34

mTOR inhibitors: inhibits transition from _ to _ phase

Answer 34

G1 to S phase

Question 35

what is Belatacept

Answer 35

CTLA4-Ig fusion protein

Co stimulatory blocker: binds to CD80 CD86 of APC

Question 36

Direct allorecognition depends on ___ DC

Indirect allorecognition depends on ___ DC

Answer 36

Donor

Recipient

Question 37

what is Banff classification?

Answer 37

renal allograft bx

1 normal 2 Ab 3 borderline 4 TCMR 5 interstitial fibrosis and tubular atrophy 6 others

Question 38

prevalence of asymptomatic stones in donors = ?

Answer 38

5%

Question 39

what is PCKD?

Answer 39

inherited
cystic explansion
renal enlargement , insufficiency
extra-renal

Question 40

ADPKD
Gene
Ch
Protein

Answer 40

PKD1 gene : Ch16 : polycystin1 protein

PKD2 gene : Ch4 : polycystin2 protein

Question 41

ARPKD
Gene
Ch
Protein

Answer 41

PKHD1 gene
Ch 6
fibrocystin protein

Question 42

ADPKD
Mean growth rate: _
Incidence of intra-cranial aneurysm: _

Answer 42

5.3%

8%

Question 43

ADPKD

indication for screening for aneurysms

Answer 43

age < 60
FHx SAH
High risk jobs

Question 44

how to evaluate a relative who wants to donate to a ADPKD patient, wrt renal cysts?

Answer 44

age dependent: < 30, 30 - 39 , >= 40

USG, MRI, genetic tests

Question 45

what is Ravine criteria?

Answer 45

imaging diagnostic criteria of ADPKD for at-risk individuals

Question 46

T/ F : Post-transplant for ADPKD

Native kidneys will shrink 38%

Answer 46

True

Question 47

minimum USG criteria for AVF maturity at 4 weeks

Answer 47

400ml/min

4mm in diameter