Renal replacement therapy 2

Question 1

Where is a transplanted kidney placed and what happens the recipients kidneys?

Answer 1

iliac fossa and anastamosed to iliac vessels

remain in situ unless very large eg PKD or infected eg pyelonephritis

Question 2

4 ways in which the donors kidneys are preserved

Answer 2

cold storage solutions
minimise oedema
preserve integrity of tissues
buffer free radicals

Question 3

Vascular complications of renal transplantation

Answer 3

bleeding - anastamotic sites, perirenal haematoma
arterial or venous thrombus
lymphocele

Question 4

Ureteric complications of renal transplantation and infection

Answer 4

urine leak

wound site infection

Question 5

Corticosteroids side effects

Answer 5

hypertension, hyperglycaemia, infections, bone loss, GI bleeds

Question 6

Name some medications used for immunosuppression

Answer 6

CCS
calcineurin inhibitors eg tacrolimus, cyclosporine
belatacept

Question 7

General side effects of the medications used for immunosuppression after a renal transplant

Answer 7

hyperglycaemia, AKI, malignancy, infections, gout, hyperlipidaemia, pneumonia

Question 8

Immunosuppression protocols

Answer 8

basiliximab - induction
maintained on steorids, tacrolimus and mycophenolate
although steroid and CNI free is possible

Question 9

Types of kidney donors

Answer 9

deceased - brain death or cardiac death
- standard and extended criteria
living donor - related
- unrelated –> spouse, altruistic, paired/pooled, ABO/HLA incompatible

Question 10

Brain death criteria

Answer 10

coma and unresponsive to stimuli 
apnoea off ventilator despite CO2 build up 
absence of cephalic reflexes 
body temperature 
absence of drug intoxication

Question 11

What cephalic reflexes not seen in brain death criteria?

Answer 11

gag, corneal, oculovestibular, oculocephalic, pupillary

purely spinal reflexes may be seen

Question 12

Extended criteria for donor

Answer 12

age >60

age 50-59 + hypertension, cerebrovascular accident or terminal creatinine of >132micromol/l

Question 13

Explain paired donation

Answer 13

4 people - 2 donors and 2 recipients 
paired together (2 pairs of people who know each other)
give kidneys to opposite recipient as better match

Question 14

What starts a pooled donation?

Answer 14

starts with altruistic donor

Question 15

4 main complications after renal transplantation

Answer 15

rejection
infection
cardiovascular
malignancy

Question 16

2 types of rejection after transplant

Answer 16

cell mediated

humoral - antibody mediated

Question 17

Cardiovascular complications after a renal transplantation

Answer 17

underlying renal disease 
CRF 
hypertension 
hyperlipidaemia 
PT diabetes

Question 18

What causes hyper acute rejection?

Answer 18

pre existing alloreactivity to the donor

Question 19

What virus is prophylaxis given for first 6 months after transplant?

Answer 19

CMV

Question 20

2 ways recipient Is infected with CMV?

Answer 20

from donor

reactivate latent virus

Question 21

CMV tissue related disease

Answer 21

hepatitis 
pneumonitis 
retinitis 
nephritis 
colitis 
gastroenteritis

Question 22

Name polyomaviride viruses

Answer 22

BK
JC
murinepyeloma virus
SV40

Question 23

BK virus manifestations after renal transplant

Answer 23

ureteral stenosis
interstitial nephritis
ESRF

Question 24

Risk factors for BKAN

Answer 24

intensity of immunosuppression eg tacrolimus
patient - age, male, DM, white, negative BK serum
organ - HLA mismatch, graft injury
viral - epitope changes

Question 25

Outcome of BKAN

Answer 25

allograft dysfunction

loss of graft in 45-80%

Question 26

Treatment of BKAN

Answer 26

reduce immunosuppression

anti viral therapy

Question 27

Most common cancer after renal transplant?

Answer 27

non melanoma skin cancer

lymphoma and sarcoma