Renal Transplant
|
Incidental findings
|
Finger prick / lipohypertrophy suggesting DM
|
|
+ve signs
|
'This patient has end stage renal failure as evidenced scar in the
right iliac fossa with transplanted kidney palpable' ± Bilateral
masses in flanks suggesting polycystic kidney disease as aetiology.
Renal replacement: Radiocephalic/brachiocephalic fistula or PD
catheter/scar. Comment on whether fistula is functional and whether
there is evidence of needling.
|
|
Differential diagnosis
|
If no specific cause found 'The most common aetiologies in the UK are ...'
|
|
Function
|
Rejection: 'The graft is non-tender, there are no scratch marks suggestive of uraemia'
Fluid balance: JVP/basal creps/able to lie flat
Immunosupression: 'There are purpora suggestive of steriod usage,
multiple warts consistent with azathioprine and hypertrichosis and gum
hypertrophy consistent with cyclosporine'
|
Extensions
-
Look for III nerve palsy of previous subarachnoid / aneurysm
-
Ask to check the blood pressure
Causes of end stage renal failure
Diabetes mellitus
Hypertension
Glomerulonephritis
Polycystic kidney disease
Notes
-
Haemolytic uraemic syndrome and foclal glomerulosclerosis: recurrence within graft common.
-
Graft survival post renal transplant: HLA identical living 88% 5y, 70%
10y; cadaver / non-HLA identical donor ~70% 5y, 50% 10y.
-
Complications of transplant: Infection (CMV, PCP); Hypertension (ciclosporin); Malignancy (lymphomas, skin cancer)
-
Combined kidney-pancreas transplant prolongs survival in patients with diabetes and ESRF
-
Acute rejection: Lymphocytic intersitial infiltrate, biopsy kidney,
treated high dose methyl pred, antilymphocyte globuline, OKT3
-
Chronic rejection interstitial fibrosis, atrophy of tubules
-
Chronic kidney disease stages 1-5 defined by GFR (15/30/60/90)
