Renal Replacement Therapy Transplantation Flashcards Preview

Systems - Urinary > Renal Replacement Therapy Transplantation > Flashcards

Flashcards in Renal Replacement Therapy Transplantation Deck (21):
1

Where is the transplanted kidney placed?

Placed into the iliac fossa and anastomosed to the iliac vessels

2

What are the indications for native nephrectomy?

Indications for native nephrectomy include size (polycystic kidneys) and infection (chronic pyelonephritis)

3

What are the transplant surgical complications of renal transplantation?

Vascular - bleeding (usually anastomotic sites, perirenal haematoma can be arterial or venous)

Arterial thrombosis

Venous thrombosis

Lymphocele - collection of lymphatic fluid in the body not bordered by epithelial lining

Ureteric - urine leak

Infections

 

 

4

What are the immunosuppressive agents?

Corticosteroids

Calcineurin inhibitors

¤Tacrolimus, Cyclosporine

Anti-proliefratives

¤Mycophenolate mofetil, Azathioprine

mTOR inhibitors

¤Sirolimus

Costimulatory signal blockers

¤Belatacept

Depleting agents

¤Basiliximab ( anti-CD25), Anti-thymocyte globulin (ATG), Rituximab (anti-CD20)

5

What are the side effects of corticosteroids, tacrolimus, cyclosporin, mycophenolate mofetil, sirolimus, belatacept?

6

Immunosuppresion protocols

Induction: Basiliximab

Maintenance: Tacrolimus + Mycophenolate + steroids

Steroid free is possible

Others: CNI-free using Belatacept

7

What are the types of donors?

Deceased donors (after brain death or cardiac death)

Living donors

(living related donor, unrelated - spousal, alturistim, paired / pooled)

8

Pooled donation

9

What is the compensatory increase in GFR of remaining kidney after donation?

Compensatory increase in GFR of remaining kidney to 70% of pre-donation values

Compensatory increase is greater in younger donors

10

What are the complications after renal transplantation?

Rejection

¤Cell mediated

¤Humoral (Ab mediated)

Cardiovascular

¤Underlying renal disease

¤CRF (chronic renal failure)

¤Hypertension

¤Hyperlipidaemia

¤PT Diabetes (new onset)

 

Infective

¤Bacterial

¤Viral

¤Fungal

 

Malignancy

¤Skin

¤Lymphoma

¤Solid Cancers

 

11

What are the mechanisms of acute rejection?

T cell mediated rejection (TCMR)

Acute antibody mediated rejection (ABMR)

12

What is the most important transplant related infection?

Cytomegalovirus - affects 8% of transplant recipients

 

HIgh mortality and morbidity

13

How is cytomegalovirus infection stimulated?

Transmission from donor tissue

Reactivation of latent virus

14

What are examples of cytomegalovirus viraemias - tissue invasive disease?

Pneumonitis

Hepatitis

Retinitis

Gastroenteritis

Colitis

Nephritis

15

Define polyomaviridae

Family of viruses

16

Name two polyomaviridae

BK - associated with patients who have had a kidney transplant - remains latent until immunocompromised - clinical manifestations include renal dysfunction, abnormal urinalysis. BK nephropathy.

 

JC virus - when immunocompromised such as in the case of AIDs or immunosuppression - causes  progressive multifocal leukoencephalopathy (PML)

 

Others include SV40 virus and murine polyoma virus

17

What are the clinical manifestations of BK virus?

Renal transplantation: Ureteral stenosis, interstitial nephritis, ESRF

Bone Marrow transplantation: Haemorrhagic cystitis, pneumonitis, hepatitis

ADIS: Nephritis, ESRF, Retinitis, meningioencephalitis, pneumonitis

18

What are the risk factors for BKVAN (BK virus associated nephropathy)

Intensity of immunosuppression

  - tacrolimus, mycophenolate mofetil, antilymphocyte globulins

Patient determinants

  - older age, male gender, white ethnicity, DM, negative BKV serostatus (paediatric recipients)

Organ determinants

  - graft injury, HLA mismatches, ureteral stents

Viral determinants

  - changes in epitopes of viral capsid protein VP-1

19

What is the outcome of BKVAN 

Allograft dysfunction

Loss of graft in 45-80

20

Wha is the treatment for BKAN?

Reduce immunosuppression

Antiviral therapy:

-Cidofovir +/- IVIG

- Leflunomide

 

21

What are the common malignancies after renal transplantation?