Renal Transplantation #2

Question 1

Acute cellular rejection

Answer 1

Can occur at any time

Increased serum creatinine, HTN, edema

Question 2

Chronic Rejection Contributin Factors

Answer 2

Calcineurin-induced nephrotoxcity
HTN
Infection

Question 3

***First line for low-risk patients

Answer 3

IL2 Receptor Antagonists

Basiliximab

Question 4

***First line for high-risk patients

Answer 4

Lymphocyte-depleting agents
Atgam (ATG)
Thymoglobulin (RATG)

Question 5

RATG can also be used to treat

Answer 5

Acute rejections

Question 6

Lymphocyte-depleting agents (ATG/RATG) have a risk for

Answer 6

Phlebitis (slowly adminster)
Anaphylaxisis (monitor vitals)
Thrombocytopenia/leukopenia (monitor CBC)

Question 7

Option for high=risk patient and resistant to other medications

Answer 7

Alemtuzumab

Question 8

Maintenance Therapy

Answer 8

High dose steroids which are tapered off quickly

Question 9

Typical maintenance dose regimen

Answer 9

Calcineurin inhibitor + Anti-proliferative agent +/- corticosteroids

Question 10

Calcineurin inhibitors

Answer 10

***Tacrolimus (immediate and extended release)

Cyclosporine and modified cyclosporine (brands are not interchangeable)

Question 11

Calcineurin inhibitors Monitoring

Answer 11

Immediate post operative period
Changes in meds or adjustments
Decline in kidney function
Trough: 12 hrs after dose

Question 12

Tacrolimus AE

Answer 12

Nephrotoxicity
Neurotoxicity
Hyperglycemia
Alopecia

Question 13

Cyclosporine AE

Answer 13

Nephrotoxicity
HTN
Hirsutism
Gingival hyperplasia

Question 14

Anti-proliferative Agents

Answer 14

***Mycophenolate
Azathioprine
- Used for acute rejection

Question 15

Mycophenolate AE

Answer 15

Leukopenia
Thrommbocytopenia
Nausea

Question 16

Azathioprine AE

Answer 16

Leukopenia

Thrombocytopenia

Question 17

Corticosteroids

Answer 17

D/c after 1st week

Avoid abrupt d/c if longterm

Question 18

Corticosteroids AE

Answer 18

Hyperglycemia/DM
Sodium/Water retention
HTN

Question 19

Proliferation Signal Inhibitors Sirolimus

Answer 19

Rejection Prevention

Used with mycophenolate to avoid CNI use

Question 20

Sirolimus AE

Answer 20

Impaired wound healing

Myelosuppression

Question 21

Proliferative Signal Inhibitor Everolimus

Answer 21

Approved for use with basiliximab, cyclosporine and corticosteroids
CNI-sparing protocol
AE: Myelosuppression

Question 22

Costimulatory Signal Inhibitor

Answer 22

Belatacept
Combo with basiliximab induction, mycophenolate and corticosteroids
Replace CNI

Question 23

Cytomeglaovirus (CMV) Infection Prophylaxis/Treatement

Answer 23

P: >/= 3 months after transplant or 6 weeks for an acute rejection
T: Ganiciclovir (serious) and Valganciclovir (mild & oral)
- Same drugs in P

Question 24

PCP Infection P/T

Answer 24

P: 3-6 months after transplantation or >/= 6 weeks during and after acute [batrim]
T: High dose IV bactrim, corticosteroids for moderate, and reduce immunosuppressive meds

Question 25

UTI P/T

Answer 25

P: Bactrim for >/= 6 months after transplantation T: Hospitalization and IV abx if pyleonephritis

Question 26

Medication induced HTN

Answer 26

``` Corticosteroids Cyclosporine Tacrolimus Cyclo > Tacro - This impairs graft functions ```

Question 27

HTN Treatment

Answer 27

Calcium channel blockers ACEi/ARB (esp with proteinuria) Diuretics (CNI induced) BB (last line)

Question 28

Causes of dyslipidemia

Answer 28

Corticosteroids Clacineurin inhibitors (cyclo > tacro) BB/Diuretics

Question 29

Treatment of dyslipidemia

Answer 29

Statins

Question 30

Hyperglycemia causes

Answer 30

``` Corticosteroids Calcineurin inhibitors (Tacro > cyclo) ```

Question 31

Hyperglycemia treatment

Answer 31

Insulin | Glipizide > glyburide