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8. Urology (Medical Knowledge) > Renal Replacement Therapy 2 > Flashcards

Renal Replacement Therapy 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

Where is the transplanted kidney usually located in the body?

A

Iliac fossa

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2
Q

What vessels is the transplanted kidney anastomosed to?

A

Iliac vessels

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3
Q

What happens to the native kidney when a kidney is transplanted?

A

Is usually left in situ

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4
Q

What are indicates for native nephrectomy?

A

Size (polycystic kidneys)

Infection (chronic pyelonephritis)

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5
Q

How is preservation of the donor kidney achieved?

A
  • Cold storage solutions
  • Minimise oedema
  • Preserve integrity of tissues
  • Buffer free radicals
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6
Q

What are some complications with kidney transplants?

A
  • Vascular complications
    • Bleeding
      • Usually anastomotic sites
      • Perirenal haematoma can be arterial or venous
    • Arterial thrombosis
    • Venous thrombosis
    • Lymphocele
  • Ureteric
    • Urine leak
  • Infections
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7
Q

How is immunosuppression achieved after a kidney transplant?

A
  • Corticosteroids
  • Calcineurin inhibitors
    • Tacrolimus, cyclosporine
  • Anti-proliefratives
    • Mycophenolate mofetil, azathioprine
  • mTOR inhibitors
    • Sirolimus
  • Costimulatory signal blockers
    • Belatacept
  • Deleting agents
    • Basiliximab ( anti-CD25), Anti-thymocyte globulin (ATG), Rituximab (anti-CD20)
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8
Q

What are side effects of corticosteroids?

A
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9
Q

What are side effects of tacrolimus?

A
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10
Q

What are side effects of cyclosporin?

A
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11
Q

What are side effects of mycophenolate mofetil?

A
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12
Q

What are side effects of sirolimus?

A
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13
Q

What are side effects of belatacept?

A
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14
Q

What are side effects of ATG?

A
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15
Q

Explain the typical immunosuppression protocol?

A
  • Induction
    • Basiliximab
  • Maintenance
    • Tacrolimus and mycophenolate and steroids
  • Steroid free is possible
  • Others
    • CNI-free using belatacept
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16
Q

What are some different types of donors?

A
  • Decreased donors
    • Donation after brain death/DBD
      • Standard/extended criteria
    • Donation after cardiac death/DCD
      • Standard/extended criteria
  • Living donors
    • Living related donor
    • Living unrelated donor
      • Spousal
      • Altruistic
      • Paired/pooled
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17
Q

What does DBD stand for?

A

Donation after brain death

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18
Q

What does DCD stand for?

A

Donation are cardiac death

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19
Q

What is the criteria to be considered a donor after brain death?

A
  • Coma, unresponsive to stimuli
  • Apnoea off ventilator (with oxygenation) despite build-up of CO2
  • Absence of cephalic reflexes
    • Pupillary
    • Oculocephalic
    • Oculovestibular
    • Corneal
    • Gag
    • Purely spinal reflexes may be present
  • Body temperature above 34oC
  • Absence of drug intoxication
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20
Q

What are the 2 kinds of donor criteria?

A
  • Standard criteria (SCD)
  • Extended criteria (ECD)
    • Donor aged over 60
    • Donor aged 50-59 with history of hypertension, death from cerebrovascular accident or terminal creatinine of over 123umol/L
21
Q

What does SCD stand for?

A

Standard criteria donor

22
Q

What does ECD stand for?

A

Extended criteria donor

23
Q

When is somone considered to be an extended criteria donor?

A
  • Donor aged 50-59 with history of hypertension, death from cerebrovascular accident or terminal creatinine of over 123umol/L
24
Q

Is there a gap between supply and demand for kidney transplants?

A

There is way more demand than supply

25
Q

Does whether the donor is living or deceased impact the survival time of the person recieving the transplant?

A

Yes, donations from living donors are better

26
Q

Are most kidney donations from living or deceased donors?

A

Deceased donors

27
Q

What is the average waiting time for a kidney donation for adults and children?

A

Adults - 845 to 883 days

Children - 205 to 327 days

28
Q

Does the amount of people on dialysis or with a transplant change depending on age?

A

Yes, more older people are on dialysis and younger people get transplants

29
Q

Who could living kidney donations come from?

A
  • Liver related donor
  • Liver unrelated donor (such as spousal)
  • Liver unrelated donor (altruistic, non-directed)
  • Paired/pooled
  • ABO incompatible/HLA incompatible
30
Q

What is paired pool and pooled donation?

A

The pair may be matched to another couple in a similar situation so that both people in need of a transplant receive a matched organ or part organ. Pooled donation is where more than two pairs of donors and recipients are involved in the swap.

31
Q

Are the long term consequences for kidney donors severe?

A

No, they appear to be minor

32
Q

Summarise the risk of kidney donation for the donor?

A
  • Similar patient survival to general population
  • Lower rate of ESRD compared to general population
  • Compensatory increase in GFR remaining kidney to 70% of pre-donation values
  • Older age and high BMI associated with GFR <60
33
Q

What are some possible complications after renal transplantation?

A
  • Rejection
    • Cell mediated
    • Humoral (ab mediated)
  • Cardiovascular
    • Underlying renal disease
    • CRF
    • Hypertension
    • Hyperlipidaemia
    • PT diabetes
  • Infective
    • Bacterial
    • Viral
    • Fungal
  • Malignancy
    • Skin
    • Lymphoma
    • Solid cancers
34
Q

What are the 2 different kinds of acute renal rejection?

A
  • T cell mediated rejection (TCMR)
    • Tubulointersitial (Banff I)
    • Arteritis/endothelilitis (Banff II)
    • Arterial fibrinoid necrosis (Banff III)
  • Acute antibody mediated rejection (ABMR)
    • ATN-like (Banff I)
    • Caillaries and or glomerular inflammation (Banff II)
    • Arterial inflammation (Banff III)
35
Q

What does TCMR stand for?

A

T cell mediated rejection

36
Q

What does ABMR stand for?

A

Acute antibody mediated rejection

37
Q

What is used to classify the biopsies from solid organ translants?

A

The Banff Classification of Allograft Pathology

38
Q

What is the most important transplant related infection?

A

Cytomegalovirus

39
Q

How are transplant patients infected with cytomegalovirus?

A
  • Transmission from donor tissue
  • Reactivation of latent virus
40
Q

How is the likelihood of cytomegalovirus infection destroying the graft reduced?

A

Prophylaxis treatment

41
Q

What are tissue invasive disease that can affect a patient after receiving a kidney transplant?

A
  • Pneumonitis
  • Hepatitis
  • Retinitis
  • Gastroenteritis
  • Colitis
  • Nephritis
42
Q

Other than cytomegalovirus, what other virus often affects patients after a kidney transplant?

A

Polyomaviridae

43
Q

What are the different kinds of polyomaviridae?

A
  • BK virus
  • JC virus
  • Murine polyoma virus
  • SV40
44
Q

What is the clinical presentation of the BK polyomaviridae virus?

A
45
Q

What does BKAN stand for?

A

BK virus nephropathy

46
Q

What are risk factors for BK virus nephropathy (BKVN)?

A
  • Intensity of immunosuppression
  • Patient determinants
    • Older age, male gender, whte ethnicity, DM
  • Organ determinants
    • Graft injury, HLA mismatches, ureteral stents
  • Viral determinants
    • Changes in epitopes of viral capsid protein VP-1
47
Q

What are BKAN outcomes?

A
  • Allograft dysfunction
  • Loss of graft in 45-80%
48
Q

What is the treatment of BKAN?

A
  • Reduce immunosuppression
  • Antiviral therapy
    • Cidofovir with or without IVIG
    • Leflunomide
49
Q

What are the most common malignancies that occur after renal transplant?

A

8. Urology (Medical Knowledge) (17 decks)

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