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Renal Transplant (Viva (Hx (Current health (Immunosuppression (Infection:…

- - - - DM
      - GN
    - - Cadaveric or live
      - Any complications: e.g. urinary leaks, infection
    - - Acute rejection: fever, graft pain
      - Graft function: Cr levels, BP, urine output
      - Immunosuppression
        
        Infection: e.g. CMV pneumonitis
        
        Skin Ca
      - CV risk
  - - - Dip: haematuria, proteinuria
      - MC+S
    - - FBC: infection
      - U+E: eGFR – look @ trend
      - LFTs: ciclosporin can → hepatic dysfunction
      - Fasting glucose: tacrolimus is diabetogenic
      - Drug levels: ciclosporin, tacrolimus
- - - - HTN
        Pallor
    - - AV fistula (or scar)
      - Tunnelled dialysis scars
      - Tenchkhoff catheter scars
    - - Cushingoid
      - Skin tumours: AKs, SCC (100x ↑ risk), BCC and MM
      - Gingival hypertrophy: ciclosporin
    - - DM
        Finger pricks from BM monitoring
        Insulin marks on abdomen, lipodystrophy
      - Cystic Kidney Disease
        Nephrectomy scars or ballotable kidneys
      - Connective Tissue Disease
        SLE, SS, RA
  - - - Rutherford Morrison Scar in RIF
        Nephrectomy scars
        Tenchkoff catheter scars
    - - Smooth oval mass under scar
        Dull PN
        Can get below it
        Doesn’t move with respiration
    - - Renal bruit over transplant
  - - - Evidence of immunosuppression
      - Signs of a cause: DM and PKD
      - Working Tx
        
        Renal replacement therapy not in use
        
        No pain over Tx site
    - - Drugs: ciclosporin, phenytoin, nifedipine
      - Familial
      - AML
      - Scurvy
      - Pregnancy
- - - - Path: ABO incompatibility
      - Presentation: thrombosis and SIRS
    - - Path: Cell-mediated response
      - Presentation
        
        Fever and graft pain
        ↓ urine output
        ↑ Cr
      - Rx: Responsive to immunosuppression
    - - Presentation: Gradual ↑ in Cr and proteinuria
      - Path: Interstitial fibrosis + tubular atrophy
      - Rx: supportive, not responsive to immunosuppression
  - - - Nephrotoxic: may contribute to chronic rejection
      - Gingival hypertrophy
      - Hypertrichosis
      - Hepatic dysfunction
    - - < nephrotoxicity cf. ciclosporin
      - Diabetogenic
      - Cardiomyopathy
      - Neurotoxicity: e.g. peripheral neuropathy
    - - ↑ risk of infection: CMV, PCP, fungi, warts
      - ↑ risk of malignancy
        
        Skin: SCC, BCC, MM, Kaposi’s
        
        Post-Tx lymphoproliferative disease (secondary EBV)
    - - Hypertension
      - Atheromatous vascular disease
        A leading cause of death