Renal transplantation 2 Flashcards

1
Q

What is the treatment given to patients following a kidney transplant in general terms ?

A

Immunosuppressive treatment

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2
Q

What are the 3 classes of immunosuppressive treatment given to patients following a transplant ?

A
  • Calcineurin Inhibitors - Cyclosporin and Tacrolimus
  • Azathioprine and Mycophenolate
  • Steroids
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3
Q

What is the action of Calcineurin Inhibitors?

A

Act by inhibiting activation of T helper cells this:

  • Reduces NK and cytotoxic T cell activation
  • Decrease cytokine release so prevent B cell proliferation and antibody production
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4
Q

What are some of the side effects of calcineurin inhibitors ?

A
  • Renal Dysfunction,
  • Hypertension,
  • Diabetes,
  • Tremors
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5
Q

What is the action of Azathioprine and Mycophenolate?

A
  • Antimetabolites by blocking purine synthesis
  • Leads to suppression of proliferation of lymphocytes and B cells (so good for antibody mediated rejection)
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6
Q

What are the side effects of azathioprine and mycophenolate ?

A
  • Leucopaenia (low WBC’s)
  • Anaemia
  • GI side effects
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7
Q

What drug must azathioprine not be given along side and why?

A
  • Must not be given along side allopurinol
  • As it increases the activity of azathioprine by x 30 which then causes aplastic anaemia and very bad leucopaenia which is really bad for someone already at risk of infections
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8
Q

What is the action of steroids in immunosuppresion ?

A

Act non selectively to suppress activity of T cells and proliferation of B cells.

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9
Q

What are the side effects of steroids ?

A
  • Osteoporosis
  • Weight Gain
  • Infection
  • Diabetes
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10
Q

What is the immunosuppressive treatment of patients following a kidney transplant ?

A

Induction therapy (so initially) - Steroids, mycophenolate, cyclosporin, tacrolimus, antibodies

Consolidation therapy - Steroids, mycopheonlate, cyclosporin, Tacrolimus

Maintenance therapy - Steroids, myclophenolate, cyclosporin, Tacrolimus

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11
Q

What are some of the reasons a graft can be lost in more long term?

A
  • Chronic rejection
  • Recurrent disease
  • Cyclosporine/ Tacrolimus toxicity
  • Ischaemia
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12
Q

When should a cyclosporin level be checked?

A

As a trough level at least 8hrs post-dose.

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13
Q

What antibiotics should not be given to someone on tacrolimus and why ?

A

Do not give macrolides to someone on tacrolimus because they cause increased tacrolimus levels which turn increases K+ and Cr levels which are very toxic to the kidney. This is especially important if this is someone’s transplanted kidney.

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