122 Transplanted kidney Instruction Examine this patient’s abdomen. Salient features History • History of chronic renal failure: determine duration, aetiology (diabetes, hypertension, glomerulonephritis) • History of haemodialysis • History of arteriovenous fistula • History of transplanted kidney. Examination • Laparotomy scar (comment on the scar) • Arteriovenous fistulae in arms • Transplanted kidney felt in either right or left iliac fossa. Proceed as follows: • Tell the examiner that you would like to look for other signs of uraemia (p. 785) • Do know the differential diagnosis for masses in the right/left iliac fossa (p. 462). Diagnosis This patient has a transplanted kidney (lesion) probably required because of diabetic nephropathy, as evidenced by the sugar-free drinks by the bedside (aetiology). Questions Mention a few indications for renal transplantation End-stage renal disease: the most common diseases that result in referral of patients for transplantation include: • diabetes mellitus with renal failure • hypertensive renal disease • glomerulonephritis. Advanced-level questions Would you refer a patient for renal transplantation before instituting haemodialysis? Referral for renal transplantation need not be delayed until the patient has begun dialysis. It is acceptable and, in fact, usually preferable to refer the patient to a renal transplant unit before dialysis is required. With judicious planning on the part of the general practitioner, renal physician and transplant surgical team, transplantation can be performed even before dialysis is required. In which age group is transplantation preferred to dialysis? Infants and children have a high morbidity rate on long-term haemodialysis or peritoneal dialysis. Therefore, renal transplantation from parents or siblings improves growth and allows a more normal lifestyle. Is there any advantage to HLA-matching before transplantation? Kidneys from living related donors who are HLA identical and also red blood cell ABO matched have a 90% survival rate at 1 year; less-identical grafts tend to have a somewhat lower survival rate. Kidney transplants from matched cadaver donors survive nearly as long, especially if the receipient does not contain antibodies to donor antigens. There is some evidence that HLA mismatching has a greater effect on living related than it does on cadaveric donor kidney transplantation. Recent evidence has shown that HLA-matched kidneys, particularly for HLA-DR, HLA-B and HLA-A antigens, are associated with long-term survival of the patient. Complete matching of HLA-DR, HLA-B and HLA-A is associated with the best chance of success. HLA-DR matching appears to have the greatest impact on survival, followed by HLA-B and lastly HLA-A (N Engl J Med 1994;331:803–5). Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Abnormal gait Dystrophia myotonica Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Transplanted kidney Full access? Get Clinical Tree
122 Transplanted kidney Instruction Examine this patient’s abdomen. Salient features History • History of chronic renal failure: determine duration, aetiology (diabetes, hypertension, glomerulonephritis) • History of haemodialysis • History of arteriovenous fistula • History of transplanted kidney. Examination • Laparotomy scar (comment on the scar) • Arteriovenous fistulae in arms • Transplanted kidney felt in either right or left iliac fossa. Proceed as follows: • Tell the examiner that you would like to look for other signs of uraemia (p. 785) • Do know the differential diagnosis for masses in the right/left iliac fossa (p. 462). Diagnosis This patient has a transplanted kidney (lesion) probably required because of diabetic nephropathy, as evidenced by the sugar-free drinks by the bedside (aetiology). Questions Mention a few indications for renal transplantation End-stage renal disease: the most common diseases that result in referral of patients for transplantation include: • diabetes mellitus with renal failure • hypertensive renal disease • glomerulonephritis. Advanced-level questions Would you refer a patient for renal transplantation before instituting haemodialysis? Referral for renal transplantation need not be delayed until the patient has begun dialysis. It is acceptable and, in fact, usually preferable to refer the patient to a renal transplant unit before dialysis is required. With judicious planning on the part of the general practitioner, renal physician and transplant surgical team, transplantation can be performed even before dialysis is required. In which age group is transplantation preferred to dialysis? Infants and children have a high morbidity rate on long-term haemodialysis or peritoneal dialysis. Therefore, renal transplantation from parents or siblings improves growth and allows a more normal lifestyle. Is there any advantage to HLA-matching before transplantation? Kidneys from living related donors who are HLA identical and also red blood cell ABO matched have a 90% survival rate at 1 year; less-identical grafts tend to have a somewhat lower survival rate. Kidney transplants from matched cadaver donors survive nearly as long, especially if the receipient does not contain antibodies to donor antigens. There is some evidence that HLA mismatching has a greater effect on living related than it does on cadaveric donor kidney transplantation. Recent evidence has shown that HLA-matched kidneys, particularly for HLA-DR, HLA-B and HLA-A antigens, are associated with long-term survival of the patient. Complete matching of HLA-DR, HLA-B and HLA-A is associated with the best chance of success. HLA-DR matching appears to have the greatest impact on survival, followed by HLA-B and lastly HLA-A (N Engl J Med 1994;331:803–5). Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Abnormal gait Dystrophia myotonica Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Transplanted kidney Full access? Get Clinical Tree
