Small Group 8 End-stage Renal Disease Flashcards Preview

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Flashcards in Small Group 8 End-stage Renal Disease Deck (13):
1

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

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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

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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

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4. Know the three most common causes of ESRD.

DM
HTN
Glomerular disease

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5. List and briefly describe the common causes of renal allograft dysfunction.

rejection
toxicity of immunosuppressive drugs
infections
renal artery or ureteral obstruction
AKI: ATN**, AIN

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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

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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

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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

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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
urinary obstruction
drug toxicity- AIN
reperfusion injury

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10. Identify the primary kidney diseases that may recur in the transplanted kidney.

HUS
FSGS
Immunoglobulin A nephrophathy
Membranoproliferative glomerulonephritis
ANCA vasculitis
diabetic nephropathy
membranous nephropathy

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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

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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

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7. Describe the pathology , immune mechanism and clinical presentation of different types of transplant rejection: Chronic rejection

intimal hyperplasia and fibrosis of arteries
interstitial fibrosis
tubular atrophy
glomerulosclerosis of the graft

due to mixed humoral and cellular rejection, several types of chronic rejection include:

Chronic transplant glomerulopathy: GBM thickening with double contours and peripheral mesengial interposition

Chronic allograft nephropathy: ill-defined spectrum of changes of interstitial fibrosis and tubular atrophy with glomerulosclorsis often present