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Urinary - Conditions > Renal Transplantation > Flashcards

Renal Transplantation Flashcards

1
Q

where is a kidney transplanted to

A

the iliac fossa

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2
Q

what blood vessels are the kidney typically anastomosed onto

A

iliac vessels

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3
Q

two reasons why you might remove the native kidneys

A

polycystic kidneys or infection

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4
Q

vascular complications of transplant surgery

A

bleeding from anastomotic sites
arterial or venous thrombosis
lymphocele (collection of lymphatic fluid where it shouldn’t be)

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5
Q

2 non-vascular complications of kidney transplant

A

urine leak and infections

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6
Q

first line of immunesuppression

A

basiliximab

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7
Q

is the kidney put in or out of the peritoneum

A

outside

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8
Q

long term maintenance immunesuppression

A

tacrolimus, mycophenolate and steroids

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9
Q

what drug type does mycophenolate belong to (azathioprine is also one)

A

anti-proliferative immunosuppressants

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10
Q

ciclosporin and tacrolimus are two examples of what kind of drug

A

immunosuppressants

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11
Q

4 major side effects of the immunosuppressants used

A

hyperglycaemia, AKI, hypertension, hirtuitism

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12
Q

what does ESRD stand for

A

end-stage renal disease

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13
Q

patients with what condition should all be considered for transplant

A

end-stage renal disease

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14
Q

proportion of donors that are dead

A

85-90%

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15
Q

what immune cells are induction immunesuppressants aimed at

A

T cells

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16
Q

two types of deceased donors

A

donation after brain death/cardiac death

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17
Q

3 types of living unrelated donors

A

spousal, altruistic and paired/pooled

18
Q

principal of paired donation

A

two pairs where the donor matches the recipient of the other pair and vice versa

19
Q

principal of pooled donation

A

living donors who don’t match their intended recipient but match another

20
Q

long term, which has better survival rate, transplant or dialysis

A

transplant

21
Q

two types of acute rejection

A

T cell mediated and acute antibody mediated

22
Q

what is hyperacute rejection

A

rejection occuring within minutes of transplant, not so common

23
Q

how does T cell mediated rejection present

A

fever, swollen kidney, rapidly increasing creatinine

24
Q

histological signs of TCMR

A

lymphocytic infiltrate

25
Q

histological signs of antibody mediated rejection

A

microvascular inflammation of glomeruli and peritubular capillaries with neutrophil infiltrate

26
Q

antibody seen on stain in AMR

A

c4d

27
Q

what endocrine disorder commonly is onset following transplant

A

type 2 diabetes

28
Q

what is the most iomportant transplant related infection and how common is it

A

cytomegaolvirus - 8%

29
Q

signs of chronic rejection

A

gradual rise in creatinine, proteinuria, resistant hypertension.

30
Q

biopsy signs of chronic rejection

A

fibrosis, tubular atrophy and vascular changes

31
Q

which type of rejection is not responsive to increasing immunesuppression

A

chronic

32
Q

survival rates at 1 and 10 years

A

89% and 67%

33
Q

which donor type has a higher survival at 10 years, living or cadaveric

A

living

34
Q

how do human polyomaviruses cause cancer

A

they produce T antigens which bind to intracellular proteins and block tumour-suppressor proteins

35
Q

examples of human polyomaviruses

A

JC and BK

36
Q

risk factors for BK infection

A

intense immunosuppresion, older male white diabetic recipient, HLA mismatch

37
Q

what factor is matched between donor and recipient

A

HLA (human leukocyte antigen)

38
Q

7 contraindications of transplant

A
  1. cancer
  2. active infection
  3. uncontrolled IHD
  4. acquired immunodeficiency disease
  5. active viral hepatitis
  6. peripheral vascular disease
  7. mental incapacity
39
Q

which of these is increasing:

a. patients of transplant waiting list
b. transplants from living donors
c. transplants from dead donors

A

c. transplants from dead donors

40
Q

people live longest when given a transplant from:

a. living related
b. living unrelated
c. dead

A

a/b. a living transplant has a greater survival than a cadaveric transplant

41
Q

true/false living kidney donors are more susceptible to ESRD and have shortened life span

A

false - similar survival to GP and maybe even a lower rate of ESRD

42
Q

effect of donating a kidney on GFR

A

GFR is reduced (because half the kidneys) but the remaining kidney can compensate to up to 70% of original GFR

Urinary - Conditions (13 decks)

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