Renal Allograft

Question 1

Presentation of problem

Answer 1

Complication of immunosuppressive:

• common infection
• atypical infection eg pneumocystis jirroveci, CMV, varicella-zoster
• Malignancy (solid organ, lymphoproliferative, skin)
• post-transplant diabetes and hyperlipidaemia
• cardiovascular disease

Transplant dysfunction eg from recurrent disease or acute rejection

Surgical complications from early post-op period

Question 2

Signs

Answer 2

Scar with mass directly beneath it

Chronic immunosuppression:

• increased skin pigmentation
• more warts
• prematurely aged skin
• skin lesions or scars from excisions
• gingival hypertrophy
• tremor
• surgical or RT scars from other malignancies

Signs of RRT

• peritoneal dialysis scar/port
• AV fistula with or without signs of needling
• tunnelled catheter lines

Evidence of aetiology:

• ADPKD
• diabetes - BM stick marks, lipodystrophy at sites of insulin injection
• hearing aids (Alports syndrome)
• if no suggestion of cause then likely I be chronic glomerulonephritis (or HTN if afrocarribean)

Question 3

Evidence of non-functioning transplant

Answer 3

Hypertension
Pruritis
Fluid overload
Current evidence of dialysis