Q.740.What causes elevation of the lipid profile in R.T.x.? B
RENAL TRANSPLANT
Q.740.What causes elevation of the lipid profile in R.T.x.? 👌
A. Csp. (replace é tacrolimus), Sirolimus & Steroid therapy.
Q.741. How can u suspect R.V.T.?
A. {Abrupt anuria. +Loin pain. +🠉LDH + Doppler evidence = R.V.T.}.
Q.742.When should the diagnosis of T.M.A. be suspected?
A. The constellation of (3 high+2 Low) : { 👌 + ✌}
1. Incr. s. Cr.
2. Incr. LDH.
3. Incr. Schistocytes in blood film.
4. Low H.B.
5. Low platelet count.
Q.743.What is the D.D.? How to solve this problem? 😎 😎
A. T.M.A. can be mistaken é :
1. “Lab”. changes …. usually ”mild”.
2. Sirolimus & thymoglobulin toxicity: [Anemia + thrombocytopenia].
A. R. biopsy 🠞{Endothelial damage+arterial microangiopathy} é T.M.A.,…. prognosis is poor.
Q.744. How to treat this problem?
A. T.M.A. can be caused by: 👌
1. A.P.A🠞Pph + anticoacgulants.
2. C.N.I. 🠞 Change the drug.
3. Recurrence of the original disease (esp. non-Drr. HUS.) 🠞Pph.
Q.745.What are the causes of post R.Tx. R.A.S?
A. Post R.Tx. RAS 👌
1. Surgical trauma. 2. Atherosclerosis. 3.CMV.
Q.746. How can u evaluate the late allograft loss?
A. Late Allograft loss:
I. 50% 🠞 of ptn die é functioning graft.
II. 50%🠞 Ch. allograft dysfunction & failure:
(1) 30-40 % 🠞 CAN. (Ch. allograft Np.) :
a. True CAN: ch. Rj. (im/m. inj.).
b. CAN of mixedorigin (fibrosis/tub. atrophy).
(2) 10-20% 🠞 Others:
o Recurrent dis.
o De Novo dis.
o Ch. CNI toxicity.
Q.747. Define CAN? 😎
A.CAN is the most common (after death) cause of allograft loss. It’s defined by “Halloran” as a [State of impaired renal allograft function, 3 m. at least post Tx., independent of : 1. Ac Rj. 2. Drug toxicity. 3. Recurrent dis.. 4. De Novo dis., & é typical features é R. biopsy.].
Q.748. Describe its C.P.?
A. C.P.: { H.T. +Proteinuria +🠝 S.cr. + P.H. of Ac Rj.}.
Q.749.Describe the biopsy findings?
A. Actually not unique for CAN, but u can find: 👌
1) Atrophy & fibrosis of the tubulointerstitium. (T/I).
2) Fibrointimal thickening of the arterial wall. (B.V.).
3) Ch. T.x. glomerulopaty:
Double contour/thickening é
cpll. wall.
Segmental
sclerosis.
Damaged mesangium.
Q.750.What is the pathogenesis of CAN?
A. Pathogenesis of CAN:
(A) Allograft -dependent: 👌
· Rejection.
· Poor compliance.
· H.L.A. mismatching.
(B) Allograft -independent: ✋
o CNI toxicity.
o Ischemic damage.
o Inadequate nephron mass.
o Donor kid. disease. (H.T., age related).
o H.T., Hyperlipidemia, proteinuria.
Q.751.How to manage CAN ?
A. CAN is ttt. accordingly: {RAS : ttt , H.T.: ttt. , Hyperlipidemia: ttt., CNI : reduce or replace é MMF, Sirolimus}.
Q.752. How to improve R. allograft survival? 👍
1) 🠝Living donor (related & non-related).
2) Donor from deceased Younger donor.
3) Better donor preparation.
4) Faster matching & T.x.
5) Prevention & ttt. of Ac. Rj.
6) High quality medical care : H.T., Dyslipidemia.
7) Pre-emptive T.x.
8) Zero mismatching.
9) Reduce cold ischemic time.
10) Reduce CNI toxicity.
11)ACEI/ARBs: few physician encouraging them.
12)Nephron dosing: Sex & BMI.
Q.753.What medical problems that can be seen in R.T.x.? How to deal with them?
A. I. Hyperphosphatemia🠊due hyperphosphaturia, due to:
Glucocorticoids.
Low vit. D.🠊 Po4 wasting.
Residual hyperparathyroidism.
*** ttt.
v Po4 supplementation.
v Vit. D. analogue
v High Po4 diet (low fat dairy products).
Q.754. What else? How to treat?
A. II. Gout: Hyperurecemia, mostly due: Csp Impair renal urate clearance é 80 % of ptn., only 7% of them develop gout…
* ttt.:
1) High dose steroids.
2) Low-dose colchicine, to avoid colchicine-induced neuromyopathy.
3) Allopurinolor uricosuric drug, Probenecid, to prevent gouty attacks (only effective é GFR>30 ml/min.).
4) Switch Csp to Tacolimusé recurrent gout. ⃔
* N.B. {Reduce Aza dose (75%) é concomitant use of Allopurinol( Allo. inhibit metabolism of Aza 🠞 Serious leucopenia, or better to switch to MMF}. 💀👽💀
Q.755.What else? How to
treat?
A.III. Osteonecrosis (avascular necrosis)🠞= The most 👆serious bone complication é T.x., due to [Steroid thpy], common site🠞Hip. Dgx.🠞MRI.
*ttt.: [Rest – Joint Replacement – Osteotomy]. ✂
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