Signposts Flashcards
(14 cards)
What are the signposts for transplants? BOSH AP IP
Brief background
- aetiology
- during on waitlist
- bridging therapies
- donor match/cadaveric etc
Operative/acute period
- acute rejection
-surgical complications
Surveillance and monitoring of graft function
- euc/pft
- biopsies
- drug levels
- appointments
History of rejection
- acute va chronic
- what triggered the rejection? Aderance, infection, change in ISx
Adherence
Psychosocial issues
ISx complications
PPx and cancer screening
What are important factors for EtOH hx?
Onset
RFs
. Social
. FHx
. Psychiatric hx
Progress
. Current intake
. Timing of first drink
. Withdrawal
. History of abstinence - attempts? Success ? Reason drinking again?
Complications
. Risky behaviours
. Forensics history
. Complex withdrawals
Biological complications
. Cirrhosis
. Cardiac
. CNS - PN, wernickes, gait
Lifestyle/functional complications
. Falls
. Nutrition
. Depression
. Cognition
Social complications
. Relationship breakdown
. Employment
Understanding and insight
Amyloidosis
Sx and Ix
. If AA amyloid, duration of preceding condition
. Hx
. Sites of disease - organs involved
- AL - skin, tongue, cvs, kidneys, GI (bleed, absorption, motility), liver, neuropathy
- AA - kidney, liver/spleen, GI, cardiac (rare)
Progress and monitoring
- EUC, PCR
Management
Complications
Anaemia
Onset/duration
Aetiology
. Aetiology
. Risk factors
Symptoms
. Sx of anaemia
. Any disease exacerbated by anaemia
Management
. transfusions. Issues w transfusions
. EPO
Monitoring
Asthma
Onset
Ix for diagnosis
Risk factors
. FHx
. Atop
. Occupation
. Smoking
Progression
.
What are important questions to include in the disease progression section of a MS history?
What are important questions to include in the function section of an MS (or other neurological disorder) history?
What are important questions to include in the disease progression section of a MM history?
Then
- Hospitalisations
- Previous treatments
Now /Complications
- Calcium
- Anaemia
- Renal injury
- Bone - fractures, pain
- Infections
- Neurological complications: PN, radiculopathy, hyperviscocity syndrome
- Pain?
Current treatment
- Pharm:
1. Ortenonib induction vs. Triple induction therapy (BRD - borezomib, lenalidomide, dexmethasone)
2. Transplant
3. Ongoing lenalidomide maintenance therapy
4. More therapy if relapse
5. More and more therapy if multiply relapsed
- BiTE, CAR-T (BCMA targeting CARTs)
+/- IV ZA for 2 years, prophylactic internal fxation
+/- VZV ppx if proteasome inhibitor
- Non pharm
ISx complications
- CVS RFs
- Thalidomide/ lanolidomide: VTE, peripheral neuropathy, cytopenias, rash
- Bortezomib (Proteasome inhibitor): peripheral neuropathy (and autonomic neuropathy), diarrhoea, thrombocytopenia.
- Daratumumab (Anti CD38 mAb): transfusion reaction
- Carfilzomib (Proteasome inhibitor): Heart failure.
CAR-T (BCMA) - B-cell aplasia, hypogammoglomulnaemia, infections
What are important questions to include in the disease progression section of a SLE history?
Then
- Hospital admissions/ flares - how were these treated?
- Management since diagnosis
Now
- Current level of disease activity
○ Symptoms
○ Impact on QoL
Current treatment
- Pharm: HCQ + Pred + Vit D + other
- Non pharm
Complications and managements
- SOAP BOX MD
- Clotting (APS)
ISx complications
- HCQ: retinopathy, blue/grey pigmentation, rash, photosensitibity, BM supression
- Pred
CVS RFs
What does SOAP BRAIN MD represent
Diagnostic criteria of SLE
Serositis – Pleurisy, pericarditis
Oral ulcers
Arthritis
Photosensitivity
Blood disorders
Renal involvement
Antinuclear antibodies
Immunologic
* anti-dsDNA Ab
* anti–Smith Ab
* antiphospholipid Ab
* Low C3, C4
Neurologic disorder
Malar rash
Discoid rash
What is relevant history in a CKD history?
- Diagnosis (biopsy proven?), date of diagnosis/ duration
- Risk factors/aetiology
- Progress (rapid progression?)
Current eGFR? - Complications
a. Anaemia
b. CKD-MBD, hyperparathyroid
c. Restless legs
d. OSA
e. Gout
f. CVS
g. Uraemia: fatigue, nausea, anorexia
h. PUD
i. Malnutirtion
j. Peripheral neuropathy - Management
a. Non-pharm
- Renal diet
- Fluid restriction
b. Pharm
- Proteinuria - ACE/ARB, SGLT2i (okay to keep going if start, but probably not starting if eGFR <30)
- HTN management, aiming BP 100-120
c. Monitoring
d. Adherance
a. Fluid balance
b. Medications
c. appointments - Future planning
Options are:
i. PDx
ii. iHDx
iii. Pre-emptive transplant
What is relevant history in a dialysis history?
- Diagnosis (biopsy proven?), date of diagnosis
- RFs/aetiology
- Dialysis
a. Dialysis logistics
- Hours
- Fluid off; URR
- Dry weight
b. Current symptoms
- Post-dialysis symptoms on day of dialysis
- Intradialysis issues
§ K
§ Fluid/weight gain
§ Hypertension
§ Fatigue, nausea (speaks to effectiveness of dialysis and possible need to stop)
c. Access issues
§ Thrombus
§ Steal
§ Need for ports/multiple fistulas etc.
1. Management
a. Non-pharm
- Renal diet
- Fluid restriction
b. Pharm
- Proteinuria - ACE/ARB, SGLT2i (okay to keep going if start, but probably not starting if eGFR <30)
- HTN management, aiming BP 100-120
c. Monitoring
d. Adherance
a. Fluid balance
b. Medications
c. appointments - Complications
a. Anaemia
b. CKD-MBD, hyperparathyroid
c. Restless legs
d. OSA
e. Gout
f. CVS
g. Uraemia: fatigue, nausea, anorexia
h. PUD
i. Malnutirtion
j. Peripheral neuropathy - Management
a. Non-pharm
- Renal diet
- Fluid restriction
b. Pharm
- Proteinuria - ACE/ARB, SGLT2i (okay to keep going if start, but probably not starting if eGFR <30)
- HTN management, aiming BP 100-120
c. Monitoring
d. Adherance
a. Fluid balance
b. Medications
c. appointments - Future planning
- ?transplant
What history is important in renal transplant?
- Type/timing/match of Tx
- Living/disease
- Match (good/poor HLA match)
- CMV status
- Underlying aetiology
- Underlying aetiology
- Time on transplant wait list
- Period of dialysis prior?
- Early transplant period
- Operative complications
- Early rejection and treatment
- Late transplant period
a. Graft function - current eGFR
b. Chronic rejection - Management
a. Rx
b. Monitoring - Fz, biopsy, bloods, appointments - Complications
a. Steriod
b. CNI
MMF
What is relevant history for BMT?
- Type/timing/match of Tx
- Auto/Allo
- Match (good/poor HLA match)
- CMV status
- Underlying aetiology
- Underlying aetiology
- Time on transplant wait list
- Period of dialysis prior?
- Early transplant period
- Induction
- Consolidation
- Engraftment
- Transfusion support
- Late transplant period
a. Graft function
- Chimerism?? (ie. only donor cells present)
b. GVHD
- what organs involved, how severe - Management
a. Rx
b. Monitoring - Fz, biopsy, bloods, appointments
c. Ppx
- Infection ppx
- Canver surviellance - Complications
a. Steriod
b. CTx
