Renal transplant

Question 1

O/E look for…

Answer 1

Fistulas - functioning?
CVC scar
Tunnelled line scar
Peritoneal dialysis scar
J shape transplant scar
Nephrectomy scars
Signs of decompensation
Signs of immunosuppression - scars, SEs

Question 2

Presentation

Answer 2

1. Current mode of RRT - tunnelled CVC, AV fistula, peritoneal dialysis, renal transplant
2. Previous modes of RRT
3. Adequacy of RRT
4. Complications of RRT
5. Complications of immunosuppresive therapy
6. Aetiology of renal failure

Question 3

Clinical signs of uraemia

Answer 3

Altered mental state
Asterixis
Excoriation
Tachypnoea
Pericardial rub

Question 4

Complications of immunosuppressive therapy

Answer 4

1. Scars from previous skin cancer removal
2. Stigmata of infection
3. Ciclosporin - gum hypertrophy, hirsutism, coarse tremor, DM, HTN
   Steroids - purpura, cushingoid, DM
   Tacrolimus - DM

Question 5

Aetiology of renal failure

Answer 5

Diabetes
Glomerulonephritis
HTN
Polycystic kidney disease
Reflux nephropathy
Analgesic nephropathy

Question 6

Management of renal failure

Answer 6

Treatment -
1. treat cause, stop nephrotoxic drugs, US kidneys
2. Control BP, control CV factors
3. Treat complications

Question 7

Complications of renal failure

Answer 7

1. volume overload - reduce dietary Na and diuretics
2. Hyperkalaemia
3. Hyperphosphataemia
4. Metabolic acidosis
5. Renal osteodystrophy
6. Anaemia

Question 8

Indications for RRT

Answer 8

1. Symptomatic/complications of uraemia
2. Volume overload refractory to diuretics
3. Refractory HTN
4. Refractory hyperkalaemia
5. Refractory acidosis
6. Removal of toxins

Question 9

Complications of haemodialysis

Answer 9

1. Dialysis wash out - too much fluid removed
2. Bacteraemia
3. Bleeding
4. Dialysis related amyloidosis

Question 10

Complications of peritoneal dialysis

Answer 10

1. Bacterial peritonitis
2. Solute clearance