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Published byNigel Watts Modified over 8 years ago
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RENAL FAILURE & TRANSPLANTATION RENAL FAILURE & TRANSPLANTATION
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Renal Failure Reduced clearance of certain solutes principally excreted by the kidney The most common indicators are urea & creatinine RF could be acute or chronic
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Causes of end stage renal failure - DM 36% - Hypertensive nephrosclerosis 30% - chronic glomerulonephritis 24% - Autosomal dominant polycystic kidney disease 12% -chronic pyelonephritis In pediatric age group ( <18 year ) congenital causes predominate like cong. hypoplasia.
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Treatment of end stage CRF Treatment is by hemodialysis, peritoneal dialysis, or renal transplantation
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Renal transplantation Renal Transplantation is the treatment of choice & the most cost effective treatment for end stage renal failure. The upper age limit for renal transplantation is 70 year of age in average
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DONER RECEPIENT
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recepient evaluation: Cardiac status Malignant diseases: waiting time : 1 – 2 year for low metastatic potential 5 – 6 year for high risk tumors Infections GIT diseases like peptic ulcer GU abnormalities : MCUG, URODYNAMIC STUDY
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Pretransplant bilateral native kidney nephrectomy Seldom required Indications: Pyelonephritis Medically uncontrolled renin mediated hypertension Malignant disease Nephrotic syndrome Extremely large polycystic kidney
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Types of donors for renal transplantation Living related donors : Allograft half life is 10 year longer than cadaveric renal donation Living unrelated donors Cadaveric donors :
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Contraindications for renal transplantation Active infections including AIDS Active malignant diseases
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the donor is always left with the better kidney Left kidney is prefered due to longer renal vein
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Investigations & HLA tissue matching Tissue matching is performed for HLA – A,B,&DR antigen that are found on the 6th chromosome ABO blood grouping & cross matchin
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Types of rejections Hyperacute rejection Acute rejection Chronic rejection
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Hyperacute rejection incidence 1/1000 analogous to blood transfusion reaction, occurs immediately,preformed Ab against HLA expressed on donor renal vascular endothlium occurs as soon as blood flow to the donor kidney is established treatment : immediate transplant removal
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Acute rejection occurs between 1 st week- 1 month occurs in 25 – 55% of patient Diffrential diagnosis : ATN, ureteral obst, drugs toxisity Clinically : febrile, tenderness over the graft impaired renal function,decrease urine output. Diagnosis : renal biopsy treatment.. by steroids & immunosuppressants
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Chronic rejection Defined as a gradual progressive loss of renal function that cannot be attributed to another cu. there is no definitive treatment for this type of rejection retransplantation to be consedered
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Immunosupression : Focused on preventing & reversing acute rejection Agents used in 3 ways induction : immediately after Tx like Azathioprine & steroids maintenance : initiated once creatinine in normalised like Azathioprine & steroids, cyclosporin A treatment of acute rejection like steroids
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Complications of renal transplantation Technical 1.Delayed transplant renal artery stenosis 2.Anastamotic leak 3.Anastamotic or ureteral stricture 4.Ureteral obstruction 5.Ureterovesical disruption 6.Lymphocele
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Complications of renal transplantation,cont Non technical Infections Cancers: lymphoma, Kaposi sarcoma
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