Nphro - transplant

Question 1

treatment of choice for advanced chronic renal failure

Answer 1

transplantation

Question 2

deceased donor grafts 1 year survival

Answer 2

92%

Question 3

living donor grafts 1 year survival

Answer 3

97%

Question 4

Mortality rate after transplantations are highest

Answer 4

within the first year, ages >=50 to 60 years

Question 5

Non-heart-beating donor donation after cardiac death

category I

Answer 5

Brought in dead

Question 6

Non-heart-beating donor donation after cardiac death

category II

Answer 6

Unsuccessful resuscitation

Question 7

Non-heart-beating donor donation after cardiac death

category III

Answer 7

awaiting cardiac arrest

Question 8

Non-heart-beating donor donation after cardiac death

category IV

Answer 8

cardiac arrest after brainstem death

Question 9

Non-heart-beating donor donation after cardiac death

category V

Answer 9

cardiac arrest in a hospital patient

Question 10

scoring to quantify potential risk of graft failure after kidney transplant based on 10 donor factors

Answer 10

KDPI

Question 11

KDPI <20% kidneys are allocated to what kind of recipients?

Answer 11

potential recipients with highest expected post transplant survival

Question 12

KDPI >85% given to

Answer 12

usually older patients who are expected to fare less well on dialysis

Question 13

current standard of cares is that a candidate for transplant to be put on a deceased organ wait list should have a life expectancy of

Answer 13

> 5 years

Question 14

Immunologic contraindications to transplantation

Answer 14

ABO incompatibility
HLA Class I (A, B, C)
HLA class II (DR, DQ, DP)

Question 15

Donor selection: survival rates favor what donor?

a. 3/6 mismatched family donor
b. 6/6 mismatched family donor
c. random cadaver donor

Answer 15

A

Question 16

True of donor selection EXCEPT

a. it is important to evaluate risk of developing DM
b. renal arteriography should be performed on donors
c. deceased donors with malignant neoplastic disease can still be given provided they are on remission
d. Hep C and HIV positive organs may be used in previously infected recipients under certain circumstances

Answer 16

C; should not be given

Question 17

Increased risk of graft failure when donor is

Answer 17

elderly
or has acute renal failure
prolonged ischemia of kidney

Question 18

preferred ischemic time

Answer 18

<24 hrs. although could be for up to 48 h on cold pulsatile perfusion or with simple flushing and cooling

Question 19

Depleting agent targeting CD52 protein

Answer 19

alemtuzumab

Question 20

Two types of immunosuppressive agents given for induction

Answer 20

depleting agents

nondepleting agents

Question 21

examples of depleting agents

Answer 21

anti thymocyte globulin

alemtuzumab

Question 22

examples of non depleting agents

Answer 22

target IL-2 receptor

Question 23

Examples of antimetabolites

Answer 23

Azathioprine

mycophenolate mofetil

Question 24

Cycloporine is a/n

a. TOR inhibitor
b. Steroid
c. antimetabolite
d. Calcinuerin inhibitor

Answer 24

D

Question 25

Tacrolimus is what kind of drug?

Answer 25

Calcineurin inhibitor

Question 26

Example of TOR inhibitor

Answer 26

Sirolimus

Question 27

CD80 CD86 inihibitor

Answer 27

Belatacept

Question 28

Presentation of rejection episode

Answer 28

rise in serum crea | reduction in urine vol

Question 29

T/F are fever swelling, tenderness over the allograft common manifestations of rejection episodes?

Answer 29

no

Question 30

These drugs have an afferent arteriolar constrictor effect on the kidney and may produce permanent vascular and interstitial injury after sustained high dose therapy

Answer 30

Calcineruin inhibitors

Question 31

This is useful in ascertaining changes in renal vasculature and in renal blood flow

Answer 31

doppler utz

Question 32

Treatment for first rejection episode

Answer 32

IV methylprednisolone 50-100 mg daily for 3 days

Question 33

Treatment for first rejection episode is IV methylprednisolone 50-100 mg daily for 3 days. What is given if patient fails to respond?

Answer 33

ATG

Question 34

CMV and P. jirovecci pneumonia are common opportunistic infections in immunosuppressed patients. Prophylaxis for these infections should be given for how long?

Answer 34

6-12 months

Question 35

Infections most common during the 1st month (peritransplant)

Answer 35

wound infections herpes virus oral candidiasis UTI

Question 36

Infections most common during the 1-6 mos. (early)

Answer 36

``` P. carinii Legionella Listeria CMV HepB HpC ```

Question 37

Infections most common during the >6 mos (late)

Answer 37

``` Aspergillus Nocardia BK virus (polyoma) Herpes zoster Hep B Hep C ```

Question 38

most common malignant lesions in immunosuppressed

Answer 38

``` cancer of the skin lips cervix lymphomas ```

Question 39

True of complications of kidney trnasplant EXCEPT a. higher incidence of death from MI and Stroke b. more than 50% of renal recipient mortality is associated with Cardiovascular disease c. CCBs are more frequently used initially for hypertension in posttransplant patients d. Hypercalcemia may develop after transplant and may indicate failure of hyperplastic thyroid glands to regress

Answer 39

NOTA, all are true

Question 40

Anemia can develop post transplant attributable to

Answer 40

bone marrow suppressan immunosuppressive medications such as SAM Sirolimus Azathioprine Mycophenolate