Renal Transplant
Incidental findings
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Finger prick / lipohypertrophy suggesting DM
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+ve signs
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'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.
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Differential diagnosis
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If no specific cause found 'The most common aetiologies in the UK are ...'
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Function
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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'
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Extensions
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Look for III nerve palsy of previous subarachnoid / aneurysm
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Ask to check the blood pressure
Causes of end stage renal failure
Diabetes mellitus
Hypertension
Glomerulonephritis
Polycystic kidney disease
Notes
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Haemolytic uraemic syndrome and foclal glomerulosclerosis: recurrence within graft common.
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Graft survival post renal transplant: HLA identical living 88% 5y, 70%
10y; cadaver / non-HLA identical donor ~70% 5y, 50% 10y.
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Complications of transplant: Infection (CMV, PCP); Hypertension (ciclosporin); Malignancy (lymphomas, skin cancer)
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Combined kidney-pancreas transplant prolongs survival in patients with diabetes and ESRF
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Acute rejection: Lymphocytic intersitial infiltrate, biopsy kidney,
treated high dose methyl pred, antilymphocyte globuline, OKT3
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Chronic rejection interstitial fibrosis, atrophy of tubules
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Chronic kidney disease stages 1-5 defined by GFR (15/30/60/90)