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Renal and Urinary 3 > Renal Transplantation > Flashcards

Renal Transplantation Flashcards

1
Q

Adv of transplant

A

No need for dialysis

Imrpoved hemodynamics

Morbidity of ESRD is lifted

Independnece

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2
Q

Disadv of transplant

A

Surgical risk

Immunosuppression risk

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3
Q

Donor operation

A

Isolate celiac-foregut, SMA - midgut, and IMA-hindgut arteries

Drain mesenteric veins through liver and systemic veins through cava

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4
Q

Preservation solution

A

Remove blood,

Cooling

Replace ECF with fluid similar to IC fluid

Low freezing point

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5
Q

Pulsatile perfusion

A

Control flow, measure resistance and pressure

V=IR or I=V/R

Brain death releases cytokine storm

Kidney has increased reisstant due to nvasosspasm from brain death, cold, and vasc dz

Pump will dilate physiologic lesions (vasospasm) and not affect fixed lesions (vasc dz)

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6
Q

Recipients

A

EPTS - age, time, diabetes, previous transplant?

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7
Q

DOnors

A

KDPI

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8
Q

Sensitive

A

Panel reactive Ab

Higher result means more likely to have positive XM so no Txp

Increased priority balances that

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9
Q

Diabetes

A

Most common cause of trnapslant

Diabetic glomeruloneprhitis

CAN recur after trnasplant

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10
Q

HTN

A

Most common diagnosis

YES - can recur in trnapslant bc while HTN caused by kidney can also damage kidne y

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11
Q

POlycystic kidney dz

A

CANNOT recur after trnapslant

Various penetrance but most proress to ESRD

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12
Q

FSGS

A

INcludes IGA neprhopathy, vasculidities

Injury to podocyte by circulating factor

CAN recur

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13
Q

Obstructive

A

Post renal causes

Children - posteriro urethral valve

Elderly- BPH

CANNOT recur if you do job right

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14
Q

Goodpastures

A

Anti-GBM to collagne 4…constellation of RPGN and pulmonary hemorrhage

CAN reucr

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15
Q

Alport’s

A

XL dz of collagen 4 with deafness and lens abnormailities…affects BM

CANNOT recur…except might develop ant-GBM to wild type collagne type 4

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16
Q

Principles of immunosuppression

A

Prevent rejection, minimize infection and toxicity

17
Q

Phases of immunosupp

A

Induction - intense
Maintencnace - chronic slowly tapering

Salvae - resuce after rejection

18
Q

Immune rsponse in 1 slide

A

1 - TCR binding

2 - co stim

3 - trigger for clonal expansion

19
Q

Antiboeis

A

Binding - activate

Depleting - MOA is mediating cell death…ADCC or compliment activaqtion

20
Q

OKT3

A

Depleting Ab against CD 3…very effective

21
Q

Anti-thymocyte globulin

A

ABs to T-lymphos

POlyclonal

Non-sepcific immune response ot human lymphocytes

22
Q

Basiliximab
Alemtuzumab
Rituximab
Belatacept

A

Il-2 antag

DDepleting against CD52…present of all lymphs

Depleting against CD20s…all B cells but plasma

Humanized CTLA4 analog…competitive inhibt of CD80/86

23
Q

Eculizumab
Alafecept
Bortzomib

A

INhibits MAC assmelby…binds C5

LFA3 analog…inhibits LFA3.CD2 costim

Inhibitor of 26S proteosome…leads to apop

24
Q

Clacineurin ihibit

A

Second messenger to TCR

Leads to IL-2 that promotes T cell act

25
Q

Cyclosproine

A

Neprhotox, neurotox, diabetogencitiy

INcreased B cell lymphoma and cosmetic changes

26
Q

Tacroliumus

A

More efficacious than CSA but similar side effects

27
Q

CSA vs. TAC

Nephro
Diabeto
HTN
Lipids
CV risk
SKin cancer
A 
=
TAC
CSA
CSA
CSA 
=
28
Q

TAC vs CSA other

A

TAC may reduce acute, steroid reiss rejection

TAC hass btter late graft function

TAC better CV

TAC is choise

29
Q

mTOR inhibt

A

Rapamycin

Blocks isgnal 3…stops signal to final common path of clonal expansion

30
Q

mTOR pros

A

Not as effective BUT

Anti-neoplastic, anti-rpolif, may reduce CMV

31
Q

mTOR cons

A 
Delayed ATN recovery
Imapired wound healing
Hepatic artery thrombosis
Thrombocyto
Hyperlipid
Mouth ulcers
32
Q

azathiprine

A

Puring analog…prodrug of 6-MP

Inhibits PRPP amidotransferase…rate limiting purine syntehsis step

33
Q

Inosine monophosphate dehydrogenase inhibitors

A

Purine synth inhibitor

Like an anti-T cell antibiotic…interferes with pruien synthesis and T cells lack a slavage pathway

Mcyphenolic acid

34
Q

Mycophenolic acid pros and cons

A

Use without monitioring…effective in combo

Cons - diarrhea, anemia, neutropneia

35
Q

Phases

A

Induction - thymoglublin, basilizimab

Main - CNI, anti-prolifs, steroids

Renal and Urinary 3 (22 decks)

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