Renal Replacement Therapy - Transplantation Flashcards
where is the transplanted kidney placed?
iliac fossa
what are the indications for a native nephrectomy?
size i.e. polycystic kidneys
infection i.e. chronic pyelonephritis
- otherwise, the non-functioning kidney remains in the body
what is the name of the procedure for removing a kidney?
nephrectomy
how do you preserve the donor kidney and how does this help preserve the kidney?
cold storage containers
- they minimize oedema
- preserve integrity of tissues
- buffer free radicals
what are the surgical complications from a nephrectomy ?
bleeding i.e. peri renal or sub capsular haematoma arterial / venous thrombosis lymphocele urine leak infection i.e. UTI, pneumonia
how do we minimise rejection from transplantation?
immunosuppression post transplant
what is the protocol of immunosuppression given after transplantation?
induction = Basiliximab
maintenance = Tacrolimus + Mycophenolate + Steroids
others: Belatacept
what are the side effects of Tacrolimus?
hyperglycaemia
nephrotoxicity - AKI
tremor
what are the side effects of mycophenolate?
cytopenia
GI upset
what are the side effects of belatacept?
infections
malignancy
what are the types of donors for transplantation?
deceased donors:
- donation after brain death
- donation after cardiac arrest
living donors;
- relative
- non-relative i.e. spouse, altruistic, pool/paired
what is the follow up time after a kidney transplant?
12 years
what are the complications after renal transplantation?
rejection
infection
CV i.e. hypertension, hypercholesterolaemia, diabetes,
malignancy - skin, lymphoma, solid cancers
what are the types of acute rejection from transplantation?
T cell mediated rejection
Acute antibody mediated rejection
what are the histological features associated with acute antibody mediated rejection?
microvascular inflammation with neutrophil infiltration of glomeruli and peritubular capillaries
positive C4d
