Renal transplant

Question 1

What are the clinical features present after renal transplant? (6)

Answer 1

1. Scar in lower quadrant
2. Palpable, non tender mass in lower quadrant
3. Enlarged normal kidneys - e..g PCKD
4. AV vistulas (with thrill) - has it recently been needled (used)?
5. Signs of peritoneal dialysis - small scar below or next to belly button
6. Signs in neck of previous central venous access

Question 2

What are the causes of end-stage renal failure? (7)

Answer 2

1. Diabeteic nephropathy
2. HTN
3. Glomerulonephritis
   disease
4. ADPCKD
5. Rhuematoid
6. Amyloid - hepatosplenomegaly
7. SLE

Question 3

When should renal transplant be considered?

Answer 3

When patient is in ESRF but has not yet required dialysis - as outcomes are better for transplants pre dialysis

Question 4

What is the definition of End Stage Renal Failure?

Answer 4

eGFR <15ml/min

Question 5

How do you present a renal transplant patient?

Answer 5

This patient presents with a functioning/non-functioning renal transplant.

I noted a R/L lower quadrant surgical scar with a palpable non-tender mass in the R/L lower quadrant

I noted/did not note signs of previous dialysis e.g. AV fistula

I did/did not note signs of immunosupression (steroids, ciclosporin, tacromlimus)

Question 6

What are the potential barriers to renal transplant? (7)

Answer 6

1. No match
2. Too unwell for surgery
3. Complinace with anti rejection medication
4. Malignancy
5. Persistent deep seated infection
6. Vasculitis
7. Obesity

Question 7

What are the side effects of post transplant immunosupression?

Answer 7

1. Infection e.g. CMV, pneumocystitis carnii
2. Malignancies - skin particularlu
3. Steroids - skin, bones, cushingoid
4. Ciclosportin - gum hypertrophy, hirsuitism
5. Tacrolimus - tremor

Question 8

What are the potential problems following renal transplant? (7)

Answer 8

1. Rjection - acute or chronic
2. Infections - CMV, pneumocystitis carnii
3. Skin malignancies
4. Lymphoproliferative diseases
5. New onset diabetes
6. Recurrence of original disease
7. Chronic graft dysfunction

Question 9

Transplant survival stats (of the graft not the person)

Answer 9

99% 1 year
50% 10 year

Question 10

Signs if kidney-pancreas transplant

Answer 10

Lower midline scar with palpable kidney but no overlying scar

Question 11

Superiority of live vs cadaveric kidney-pancreas transplant combinations

Answer 11

1. Combined cadaveric kidney-pancreas transplant (equal up to 10 years as live kidney then better after 10 years)
2. Live kidney
3. Live kidney + cadaveric pancreas
4. Cadaveric kidney

Question 12

What are the benefits of a kidney-panceas transplant?

Answer 12

1. ‘Cures’ diabetes
2. ‘Cures’ end stage renal failure

however, no evidence of impact on diabetic retinopathy