Flashcards in Small Group 8 End-stage Renal Disease Deck (13):
1. Recognize uremic symptoms and signs and laboratory abnormalities attributable to end-stage renal disease (ESRD).
symptoms: fatigue, anorexia, nausea and vomiting, decreased urination, pleuritic chest pain, decreased frequency and volume of urination
signs: HTN, weakness, waxy skin pallor, pale conjunctivae, pericardial rub
labs: severe anemia, hyperkalemia, AGMA, hyperphosphatemia, hypocalcemia, increased BUN and creatinine
2. List reasons for starting chronic dialysis and know which are emergent.
emergent: severe volume overload (CHF, hypoxia) that is unresponsive to diuretics, lifer threatening hyperkalemia (>6.5), acidosis unresponsive to bicarbonate
signs include asterixis, if patient is not producing urine
3. Understand the differences between the dietary prescription for a patient on dialysis versus a patient with CKD not on dialysis.
restriction of Na, P, K for both
with dialysis you have to add additional protein
4. Know the three most common causes of ESRD.
5. List and briefly describe the common causes of renal allograft dysfunction.
toxicity of immunosuppressive drugs
renal artery or ureteral obstruction
AKI: ATN**, AIN
6. Recognize histologic and immunohistochemical features of renal allograft rejection.
acute cellular rejection: dense inflammatory infiltrate to the interstitial and renal tubules (tubilitis) with intimal arteritis; interstitial shows edema and focal microhemorrhage
7. Describe the pathology , immune mechanism and clinical presentation of different types of transplant rejection: Immediate (hyperacute) rejection (antibody mediated)
preformed IgG against class HLA donor tissue (min-hrs)
is an antibody mediated cy
totoxic response to vascular endothelium, followed by thrombosis in the microvasculature and graft necrosis
endarteritis: characterized by endothelial swelling and undermining of the endothelium by lymphocytes
acute antibody mediated rejection of renal allograft shows diffuse C4d deposition in peritubular cpaillaries
8. Describe the pathogenesis of hypertension in acute transplant recipients.
transplant renal after stenosis is a subacute complication that is usually associated with severe hypertension
9. Describe the four causes of AKI in patients with a new kidney transplant, and list three appropriate tests to differentiate these causes.
vascular obstruction- ATN
drug toxicity- AIN
10. Identify the primary kidney diseases that may recur in the transplanted kidney.
Immunoglobulin A nephrophathy
7. Describe the pathology , immune mechanism and clinical presentation of different types of transplant rejection: Delayed (accelerated acute) rejection (antibody mediated)
(days to months) manifested in renal tubular injury and neutrophil marination in peritubular interstitial capillaries
C4d serves as a durable marker of antibody mediated rejection
7. Describe the pathology , immune mechanism and clinical presentation of different types of transplant rejection: Acute cellular (T-cell mediated) rejection
most common form of rejection (usually within first 6mo)
mediated by T cell infiltrate of allograft, undergo clonal expansion and cause tissue destruction (glomeruli, tubules, interstitial and blood vessels) commonly tubule-interstital
reaction to HLA class I and II antigens:
direct- receptors on host T cells recognize antigen on donor tissue
indirect- antigen presenting cells presents to helper T cells
production of cytosine, IL-2 which provides signals to helper cytotoxic T cells and promotes expansion of the T cell