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5. URINARY > URINARY Section 7: Transplant > Flashcards

URINARY Section 7: Transplant Flashcards

1
Q

the best treatment for end stage renal disease

A

tansplant

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2
Q

Where the transplanted kidney is most commonly placed

A

extraperitoneal iliac fossa so that the allograft can be anastomosed with the iliac vasculature and urinary bladder.

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3
Q

two major points to know first when thinking about resistance indices (RI)

A
  1. Kidney has an unforgiving capsule
  2. A sick kidney is a swollen kidney
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4
Q

RI =

A
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5
Q

If the meat (parenchyma) of the kidney is sick and swollen, but can’t expand because it is wrapped in a tight unforgiving capsule you can imagine the
blood vessels going through that kidney are going

A

going to get the squeeze!!

You can also probably imagine that the passive diastolic flow would be more impaired (compared to the active systolic flow) by this squeeze.

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6
Q

If the meat of the kidney becomes “sick” from whatever the cause might be {rejection, infection, inflammation, etc…) it swells =

A

Increasing resistance

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7
Q

RI should stay below?

A

Below 0.7

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8
Q

For the purpose of multiple choice, you should never use elevated RIs

A

to exclude pathology (unless the answer is normal)

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9
Q

3 flavors of Transplant Complications

A

a. Urologic
b. Vascular
c. Cancer

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10
Q

why do tranplanted kidneys have some mild hydro?

A

denervation of the transplant

loppy tone to the ureter.

If there is a true obstruction it is usually at the site of ureteral implantation to the bladder.

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11
Q

Common causes of tranplant obstruction?

A

post operative edema
scarring
technical errors leading to kinking

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12
Q

Hematoma in transplant

A

Common immediately post op
Spontenous resolution

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13
Q

Large post transplant hematoma can produe

A

hydronephrosis

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14
Q

Acute hematoma vs chronic

A

ACute = echogenic

chronic = anechoic + septated

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15
Q

Urinoma is usually found __ weeks post op

A

2 weeks

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16
Q

Urinoma on USD

A

anechoic fluid collection with no septations, that is rapidly increasing in size.

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17
Q

Where do most leaks (urine extravasation) go?

A

Ureterovesical anastomosis

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18
Q

How do you demosntrate urinoma?

A

MAG 3 nuc med

or

USD (cheaper)

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19
Q

When do lymphoceles start post op?

A

1-2 months

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20
Q

Cause of lymphocele

A

leakage of lymph from surgical disruption of lymphatics or leaking lymphatics in the setting of inflammation

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21
Q

most common fluid collection to cause transplant hydronephrosis.

A

LYmphocele

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22
Q

Ipsilateral lower extremity edema from femoral vein compression.

A

Lymphocele

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23
Q

Think Complex Collection + Heterogenous, Septa,

A

Hematoma

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24
Q

Simple Collection between the bladder and the kidney

A

Urinoma

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25
Q

Complex Hyperemic Collection

A

Abscess

26
Q

Simple Collection (may have tiny septa).

A

Lymphocele

27
Q

CT appearance of Hematoma

A

Appearance will depend on how acute it is. Acute = more dense.

28
Q

CT appearance of Urinoma

A

Ifyoudoadelayed phase you can see leakage of contrast

29
Q

CT appearance of Abscess

A

Peripheral Enhancement

30
Q

CT appearance of Lymphocele

A

If you do a delayed phase you will NOT see leakage of contrast

31
Q

Urinoma causes

A

These things happen from ischemia to the ureter or obstruction (usually)

32
Q

an immediate failure of the graft - and you rarely see this imaged. It is basically a dead on arrival transplant.

A

Hyperacute Rejection

33
Q

Acute rejection happens between -

A

Week 1-3

34
Q

Acute Tubular Necrosis (ATN)

A

The mechanism is ischemia in the kidney after they carve it out of the Hobo (presuming the transplant is from the usual donor - Hobo found floating in the river). So in the time it takes to carve it out of the Hobo and sew it into an affluent celebrity (Selena Gomez, Tracy Morgan, etc..) there is going to be some ischemia - and therefore ATN.

35
Q

transplant requiring dialysis in the first week

A

“Delayed Graft Function (DGF) ”

36
Q

Immunosuppressive therapy necessary to keep the body from rejecting the graft can ironically end up poisoning the graft.

A

Cyclosporin

37
Q

Cyclosporin Toxicity (Calcineurin Inhibitor) timing

A

Latera than ATN (around a month)

38
Q

Cellular Immune. (T-Cell) Mediated rejection

A

Chronic rejection

39
Q

Antibody / Cell Mediated rejection

A

Acute rejection

40
Q

Ischemia During “Harvesting”

A

ATN

41
Q

Nephrotoxic Reaction to Immunosuppressive

A

Cyclosporin Toxicity

42
Q

Renal artery thrombosis happens when?

A

first month (usually minutes to hours post op)

43
Q

Technical factors of Renal artery Thrombosis?

A

Kinking or torsion

44
Q

Renal artery stenosis happens when?

A

first year

45
Q

Easily the most common vascular complication of transplant.

A

Renal Artery Stenosis

46
Q

Where does renal artery stenosis happen?

A

Anastomosis (end-to-end tpyeS)

47
Q

Risk factore for renal artery stenosis?

A

CMV

48
Q

“refractory hypertension”

A

REnal artery stenosis

  • PSV > 200-300 cm/s. (some people say 340-400 cm/s)
  • PSV ratio > 1.8-2.5x (Stenotic Part vs Non Stenotic Part)
  • Tardus Parvus: Measured at the Main Renal Artery Hilum (NOT at the arcuates)
  • Anastomotic Jetting
49
Q

Renal Vein Thrombosis happens when?

A

First week

50
Q

Swollen kidney 1 week post op + reversed diasolic flow =

A

Renal Vein Thrombosis

51
Q

Reverse M sign

A

Renal Vein Thrombosis

52
Q

Biopsy + “tissue vibration artifact” =

A

Arteriovenous Fistula (AVF)

(perivascular, mosaic color assignment due to tissue vibration), with high arterial velocity, and pulsatile flow in the vein.

53
Q

Biopsy + graft infection/anastomotic dehiscence + Yin-yang

A

Pseudoaneurysm

54
Q
A

Pseudoaneurysm

Doppler with biphasic flow at the neck of the pseudoaneurysm.

54
Q

Renal transplant + Immunusuppresion therapy =

A

100x increased risk of developing CA

In particular, they get more nonmelanomatous skin cancer, lymphoma, and colon cancer

55
Q

recommendation for all renal transplant patients

A

annual skin exams

56
Q

RCC subtype in renal transplant?

A

Papillary

57
Q

This is an uncommon comphcation of organ transplant, associated with B-Cell prohferation.

A

Post Transplant Lymphoproliferative Disorder (PTLD)

58
Q

is a risk factor and that is one of the main reasons they screen for it

A

EBV

59
Q

When is Post Transplant Lymphoproliferative Disorder (PTLD) common?

A

It is most common in the first year post transplant, and often involves multiple organs.

60
Q
A

Post Transplant Lymphoproliferative Disorder (PTLD)

mass lesion encasing / replacing the hilum

61
Q

Renal Transplant +BK Virus =

A

Urothelial Malignancy

5. URINARY (19 decks)

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