Renal transplant
| Incidental findings | Finger prick / lipohypertrophy suggesting DM |
| +ve signs | ‘This patient has ESRF as evidenced scar in RIF with transplanted kidney palpable’±Bilateral masses in flanks suggesting PCKD as aetiologyRenal 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’ |
| Tests |
Extensions
- Look for III nerve palsy of previous subarachnoid / aneurysm
- Ask to check the blood pressure
Causes endstage renal failure
Diabetes mellitus
Hypertension
Glomerulonephritis
PCKD
Diabetes mellitus
Hypertension
Glomerulonephritis
PCKD
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)