Renal Transplant Patient

Question 1

Signs in renal transplant patient

Answer 1

Arms:
- AV fistula (immature, active (thrill), failed)
Neck:
- tunnelled dialysis line, scars at root of neck and chest wall from previous lines
Abdo:
- flank scar (nephectomy)
- iliac fossa scar (hockey stick, reverse J - transplant)
- peritoneal dialysis catheter: below umbilicus insertion, lateral to umbilicus exit
Fluid status:
- oedema

Question 2

Hints to causes of renal failure

Answer 2

Finger prick marks: diabetes
Polycystic kidneys: ADPKD
Sclerodactyly/beak nose: Systemic sclerosis
Rheumatoid hands/nodules: Rheumatoid
Hepatoma/splenomegaly: amyloidosis
Other organ transplants: calcineurin inhibitor nephrotoxicity
Ungual fibromata, sebaceous adenoma, PKD: tuberous sclerosis

Question 3

Signs of current renal replacement therapy

Answer 3

Haemodialysis: av fistulae, tunnelled lines
Peritoneal dialysis: abdominal catheter
Functioning transplant: no signs

Question 4

Complications of renal transplant medicines

Answer 4

Tacrolimus: fine tremor, diabetes
Ciclosporin: HTN, gum hypertrophy
Ciclosporin and azathioprine: skin damage, malignancy
Steroid side effects

Question 5

Signs of kidney-pancreas transplant

Answer 5

Midline scar with palpable kidney in iliac fossa but no overlying scar
Signs of previous DM e.g. Visual problems
Younger patient

Question 6

Top 3 causes for renal transplantation

Answer 6

Diabetic nephropathy
Glomerulonephritis
ADPKD

Question 7

Complications of transplantation

Answer 7

Infection: CMV, PJP
Rejection: acute or chronic
Increased risk of: skin malignancy, post transplant lymphoproliferative disease, CVD d/t hyperlipidemia+HTN
Recurrence of original disease
Chronic graft dysfunction

Question 8

Success rate of renal transplant

Answer 8

90% 1 year graft survival

50% 10 year graft survival