In terms of renal function, define ‘end stage renal failure’
eGFR less than 15 ml/min
Name some barriers to transplant
Donor matching (no donor no kidney)
Active or recent malignancy
Deep seated infection
Vasculitis (active)
Obesity (technical difficulty
Side effects of immunosuppression (kidneys) - Steroids
Predisposition to malignancy/infection
Steroids - thinning of skin, easy bruising and fat distribution
Side effects of immunosuppression (kidneys) - Cyclosporin
Hirsuitism, gingival hyperplasia, renal impairment
Side effects of immunosuppression (kidneys) - Tacrolimus
Tremor, NODAT (New-Onset Diabetes After Transplant)
When do you start discussions and work up for transplant
Approaching end-stage renal failure but before dialysis, When depends on availability of kidney. Outcome better if not on dialysis
Common causes of end stage renal failure
Hypertension, Diabetes, various forms of glomerulonephritidies
ADPKD
What is mortality at 1 year in patients with ascites secondary to cirrhosis?
15% at 1 year
Causes of SAAG <1.1
Nephrotic syndrome
Carcinomatosis
Protein losing entropathy]
TB
Pancreatic duck leak
Congestive Cardiac failure
Causes of raised SAG (>=1.1)
Cirrhosis
Alc Hep
Acute liver failure
Budd Chiari
Portal vein obstruction
SBP
What bloods are in non invasive liver screen
Glucose
AFP
Liver autoantibodies
FBC
U&E
LFT
Coag
Caeruloplasmin
Transferrin saturations/Ferritin
What are hand signs of liver disease?
Dupytrens contracture, Leukonychia, clubbing, palmar erythema, asterixis
What do you look for in the arms and axilla in abdo exam?
Acanthosis nigricans, loss of hair, tattoos
