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MBChB - Y2 - Systems - Urinary > Renal Replacement Therapy Transplantation > Flashcards

Renal Replacement Therapy Transplantation Flashcards

1
Q

Where is the transplanted kidney placed?

A

Placed into the iliac fossa and anastomosed to the iliac vessels

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2
Q

What are the indications for native nephrectomy?

A

Indications for native nephrectomy include size (polycystic kidneys) and infection (chronic pyelonephritis)

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3
Q

What are the transplant surgical complications of renal transplantation?

A

Vascular - bleeding (usually anastomotic sites, perirenal haematoma can be arterial or venous)

Arterial thrombosis

Venous thrombosis

Lymphocele - collection of lymphatic fluid in the body not bordered by epithelial lining

Ureteric - urine leak

Infections

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4
Q

What are the immunosuppressive agents?

A

Corticosteroids

Calcineurin inhibitors

¤Tacrolimus, Cyclosporine

Anti-proliefratives

¤Mycophenolate mofetil, Azathioprine

mTOR inhibitors

¤Sirolimus

Costimulatory signal blockers

¤Belatacept

Depleting agents

¤Basiliximab ( anti-CD25), Anti-thymocyte globulin (ATG), Rituximab (anti-CD20)

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5
Q

What are the side effects of corticosteroids, tacrolimus, cyclosporin, mycophenolate mofetil, sirolimus, belatacept?

A
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6
Q

Immunosuppresion protocols

A

Induction: Basiliximab

Maintenance: Tacrolimus + Mycophenolate + steroids

Steroid free is possible

Others: CNI-free using Belatacept

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7
Q

What are the types of donors?

A

Deceased donors (after brain death or cardiac death)

Living donors

(living related donor, unrelated - spousal, alturistim, paired / pooled)

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8
Q

Pooled donation

A
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9
Q

What is the compensatory increase in GFR of remaining kidney after donation?

A

Compensatory increase in GFR of remaining kidney to 70% of pre-donation values

Compensatory increase is greater in younger donors

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10
Q

What are the complications after renal transplantation?

A

Rejection

¤Cell mediated

¤Humoral (Ab mediated)

Cardiovascular

¤Underlying renal disease

¤CRF (chronic renal failure)

¤Hypertension

¤Hyperlipidaemia

¤PT Diabetes (new onset)

Infective

¤Bacterial

¤Viral

¤Fungal

Malignancy

¤Skin

¤Lymphoma

¤Solid Cancers

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11
Q

What are the mechanisms of acute rejection?

A

T cell mediated rejection (TCMR)

Acute antibody mediated rejection (ABMR)

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12
Q

What is the most important transplant related infection?

A

Cytomegalovirus - affects 8% of transplant recipients

HIgh mortality and morbidity

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13
Q

How is cytomegalovirus infection stimulated?

A

Transmission from donor tissue

Reactivation of latent virus

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14
Q

What are examples of cytomegalovirus viraemias - tissue invasive disease?

A

Pneumonitis

Hepatitis

Retinitis

Gastroenteritis

Colitis

Nephritis

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15
Q

Define polyomaviridae

A

Family of viruses

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16
Q

Name two polyomaviridae

A

BK - associated with patients who have had a kidney transplant - remains latent until immunocompromised - clinical manifestations include renal dysfunction, abnormal urinalysis. BK nephropathy.

JC virus - when immunocompromised such as in the case of AIDs or immunosuppression - causes progressive multifocal leukoencephalopathy (PML)

Others include SV40 virus and murine polyoma virus

17
Q

What are the clinical manifestations of BK virus?

A

Renal transplantation: Ureteral stenosis, interstitial nephritis, ESRF

Bone Marrow transplantation: Haemorrhagic cystitis, pneumonitis, hepatitis

ADIS: Nephritis, ESRF, Retinitis, meningioencephalitis, pneumonitis

18
Q

What are the risk factors for BKVAN (BK virus associated nephropathy)

A

Intensity of immunosuppression

  • tacrolimus, mycophenolate mofetil, antilymphocyte globulins

Patient determinants

  • older age, male gender, white ethnicity, DM, negative BKV serostatus (paediatric recipients)

Organ determinants

  • graft injury, HLA mismatches, ureteral stents

Viral determinants

  • changes in epitopes of viral capsid protein VP-1
19
Q

What is the outcome of BKVAN

A

Allograft dysfunction

Loss of graft in 45-80

20
Q

Wha is the treatment for BKAN?

A

Reduce immunosuppression

Antiviral therapy:

  • Cidofovir +/- IVIG
  • Leflunomide
21
Q

What are the common malignancies after renal transplantation?

A

MBChB - Y2 - Systems - Urinary (28 decks)

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