1. Renal Transplantation Basic Science Review 11/23/05

2. Which three of the following diseases leading to renal failure account for 60% of all cases? Polycystic Kidney disease Hypertensive nephrosclerosis SLE IDDM Glomerulonephritis Pyelonephritis

3. Which three of the following diseases leading to renal failure account for 60% of all cases? Polycystic Kidney disease Hypertensive nephrosclerosis SLE IDDM Glomerulonephritis Pyelonephritis

4. Which of the following are true regarding renal transplantation? Bilateral nephrectomy is still indicated prior to transplantation in special circumstances such as persistant UTI, malignant HTN, bilateral renal tumors, and large polycystic kidneys. Splenectomy prior to transplantation improves long term graft survival, but worsens short term survival. Graft survival between identical HLA haplotypes is approximately 70%. Operative mortality associated with living donor unilateral nephrectomy is on the order of 1%.

5. Which of the following are true regarding renal transplantation? Bilateral nephrectomy is still indicated prior to transplantation in special circumstances such as persistant UTI, malignant HTN, bilateral renal tumors, and large polycystic kidneys. T Splenectomy prior to transplantation improves long term graft survival, but worsens short term survival. Modestly improves early but not late graft survival. Graft survival between identical HLA haplotypes is approximately 70%. >95% Operative mortality associated with living donor unilateral nephrectomy is on the order of 1%. ~ 0.05%

6. Which of the following are contraindications to cadaveric kidney harvesting? Generalized infections including occult infections such as hepatitis and HIV. Diabetes Hypertension Any malignancy other than non-metastasizing brain tumors Infant kidneys. Donors over the age of 65.

7. Which of the following are contraindications to cadaveric kidney harvesting? Generalized infections including occult infections such as hepatitis and HIV. Yes Diabetes. No Hypertension. Yes Any malignancy other than non-metastasizing brain tumors. Yes Infant kidneys. No, but often both kidneys need to be transplanted. Donors over the age of 65. F, limited by extent of likely age-related vascular disease.

8. Which of the following are not correct regarding the recipient operation? Anesthesia may be general or regional, such as with spinal. Liberal use of muscle relaxants should be used to provide good relaxation during the vascular and ureteral anastamosis. The transplanted organ is placed in the retroperitoneal space via an oblique incision just above the inguinal ligament. The donor renal artery and vein are anastomosed end-side to the recipients renal vessels on the right side due to ease of access.

9. Which of the following are not correct regarding the recipient operation? Anesthesia may be general or regional, such as with spinal.T Liberal use of muscle relaxants should be used to provide good relaxation during the vascular and ureteral anastamosis. F, must be used carefully due to prolonged apnea in dialysis patients. The transplanted organ is placed in the retroperitoneal space via an oblique incision just above the inguinal ligament. T The donor renal artery and vein are anastomosed end-side to the recipients renal vessels on the right side due to ease of access. F, typically the vessels of the donor kidney are anastomosed to the R iliac vessels.

10. Hyperacute rejection of a transplanted kidney is characterized by: Rejection noted within minutes of revascularization of the transplanted kidney. Clinically consists of bluish discoloration of the organ, oliguria or anuria after appropriate initial urine output, evidence of decreased perfusion. Histologically, there is intraglomerular accumulation of fibrin, platelets, PMLs, and RBC’s. Can be limited by immunosuppressive or anticoagulant therapy. Correlates with the presence of antibodies against donor antigens.

11. Hyperacute rejection of a transplanted kidney is characterized by: Rejection noted within minutes of revascularization of the transplanted kidney. T Clinically consists of bluish discoloration of the organ, oliguria or anuria after appropriate initial urine output, evidence of decreased perfusion. T Histologically, there is intraglomerular accumulation of fibrin, platelets, PMLs, and RBC’s. T Can be limited by immunosuppressive or anticoagulant therapy. F, is typically refractive to above therapies. Correlates with the presence of antibodies against donor antigens. T

12. Acute cellular rejection of a transplanted kidney is characterized by: Can become evident up to years after the transplant. Typically presents with a constellation of symptoms including fevers, malaise, hypertension, and oliguria. Cannot be easily distinguished from other causes of the above sx, such as ureteral obstruction, vascular occlusion, and urinary fistula. Diagnosis of rejection is usually made based on biopsy evaluation. Histologically characterized by cellular infiltration of lymphocytes and macrophages.

13. Acute cellular rejection of a transplanted kidney is characterized by: Can become evident up to years after the transplant. T Typically presents with a constellation of symptoms including fevers, malaise, hypertension, and oliguria. T, although less commonly with the use of immuno- suppressive agents. Cannot be easily distinguished from other causes of the above sx, such as ureteral obstruction, vascular occlusion, and urinary fistula. F, perfusion scan can differentiate. Diagnosis of rejection is usually made based on biopsy evaluation. T Histologically characterized by cellular infiltration of lymphocytes and macrophages. T

14. Chronic rejection of a transplanted kidney is characterized by: Gradual, progressive loss of renal function after some period of stable function. Characterized by intimal fibroproliferative arterial lesions, thickened glomerular basement membrane, and IgM, IgG, and complement deposits. Clinically manifested by proteinuria, microscopic hematuria, and deteriorating function. Aggressive antirejection therapy and high dose corticosteroids may limit further deterioration.

15. Chronic rejection of a transplanted kidney is characterized by: Gradual, progressive loss of renal function after some period of stable function.T Characterized by intimal fibroproliferative arterial lesions, thickened glomerular basement membrane, and IgM, IgG, and complement deposits. T Clinically manifested by proteinuria, microscopic hematuria, and deteriorating function. T Aggressive antirejection therapy and high dose corticosteroids may limit further deterioration. F, antirejection therapy is ineffective and steroids only increase the risk of infections.