CLINICAL JUDGEMENT EXAM 2 170 QUESTIONS AND CORRECT
ANSWERS LATEST GRADED A+
What are the two biggest causes of ESRD and kidney transplant rejection? - answer-#1 - Diabetes
#2 - Hypertension
What are the three renal replacement treatments? - answer-1- Hemodialysis
2- Peritoneal dialysis
3- Kidney transplant
Review:
-Normal GFR rate?
-Universal donor?
-Universal recipient? - answer--GFR: 120-125 mL/hr (180 L/day)
-Universal donor: 0-
-Universal recipient: AB+
____________________ matching is essential for a successful transplant. The closer the match, the
lower the risk of transplant rejection. - answer-HLA (Human Leukocyte Antigen)
True or False. A person with HIV cannot undergo a kidney transplant. - answer-False - HIV patients can
receive a kidney but must have an *undetectable viral load* and a *CD4 count >200*
True or False. A person with Hep C is not eligible to donate a kidney. - answer-False - can donate but it
will most likely go to a patient who also already has Hep C. Whoever receives it will then go on meds for
Hep C
Where is a transplanted kidney placed? - answer-Placed in the iliac fossa anterior to the iliac crest to
allow easier access to blood supply (original kidneys are not removed)
When should a patient expect urine to begin to flow from a newly transplanted kidney?
,-In the OR
-1 hour post op
-6 hours post op
-Within 24 hours after the surgery is complete - answer--In the OR (indicates the procedure is a success)
ESRD s/s - answer-<5% of kidney function
↓GFR
↑BUN/Creatinine
↑K+ ↓Na+
Anemic (kidneys not producing erythropoetin)
Kidney Transplant complications - answer--Acute tubular necrosis
-Rejection
-Infection
Which of the following is a type of rejection that occurs within 24 to 48 hours?
-acute rejection
-hyperacute rejection
-chronic rejection
-allograft rejection
*BONUS:* How would you treat this? - answer--hyperacute rejection
*Tx:* Immediate removal of the transplanted organ
Which of the following is the most common type of rejection?
-acute rejection
-hyperacute rejection
-chronic rejection
-allograft rejection - answer--acute rejection
,A patient is post op from a kidney transplant 5 days ago. They start complaining of tenderness at the
transplant site and an inability to urinate much. Their creatinine is 2.1 and they have a fever of 101.2F.
What is a likely diagnosis?
-acute rejection
-infection
-hyperacute rejection
-acute tubular necrosis
*BONUS:* How would you treat this? - answer--acute rejection (occurs within a few days to weeks; s/s:
tenderness at site, ↑creat, fever >100, oliguria)
*Tx:* immunosuppressant therapy
Norm Creat = 0.8-1.4
Which of the following are s/s of chronic kidney rejection? Select all that apply.
-Proteinuria
-Oliguria
-K+ of 5.4
-BUN of 8
-Ca+ of 10.9 - answer--Proteinuria
-K+ of 5.4
(+↓Ca ↑K ↑P ↑BUN/Creat +Fatigue - similar to Chronic Renal Failure)
What helps to prevent acute rejection for kidney transplant recipients? - answer-IMMEDIATE
immunosuppressant medications following surgery
Which of the following are risks associated with taking immunosuppressive medications? Select all that
apply.
-tachycardia
-nephrotoxicity
-ototoxicity
, -lanugo
-hypertension
-tremors - answer--nephrotoxicity
-hypertension
-tremors
(+hyperlipidemia +hirsutism +blood dyscrasias +cataracts +gingival hyperplasia +some cancers)
Which of the following is a type of enzyme that activates CD4 T cells?
-Calcineurin
-Amylase
-Calcineurin inhibitor
-Pancreatic lipase - answer--Calcineurin (type of phosphatase)
Following a kidney transplant we want to ________________ the CD4 T cell count with medications that
are _____________________ ____________________. - answer-DECREASE CD4 T cells (which recognize
foreign bodies) with calcineurin inhibitors
Tacrolimus (Prograf) - answer-Immunosuppressant
-*MOA:* inhibits calcineurin (which usually promotes CD4 T cells which activate the immune response
against foreign bodies)
-*Uses:* Prevent rejection
-*S/E:* Nephrotoxicity (↑BUN/Creatinine), Neurotoxicity (tremors, paresthesia), Hyperglycemia,
hyperkalemia, HTN
-*NOTE:* Take on empty stomach, avoid K+ sparing diuretics (spironolactone), avoid grapefruit juice
-*WARNING:* Can cause post transplant diabetes mellitus (causes decreased insulin secretion and
increased insulin resistance)
Which of the following are side effects of tacrolimus? Select all that apply.
-↑BUN/Creatinine
ANSWERS LATEST GRADED A+
What are the two biggest causes of ESRD and kidney transplant rejection? - answer-#1 - Diabetes
#2 - Hypertension
What are the three renal replacement treatments? - answer-1- Hemodialysis
2- Peritoneal dialysis
3- Kidney transplant
Review:
-Normal GFR rate?
-Universal donor?
-Universal recipient? - answer--GFR: 120-125 mL/hr (180 L/day)
-Universal donor: 0-
-Universal recipient: AB+
____________________ matching is essential for a successful transplant. The closer the match, the
lower the risk of transplant rejection. - answer-HLA (Human Leukocyte Antigen)
True or False. A person with HIV cannot undergo a kidney transplant. - answer-False - HIV patients can
receive a kidney but must have an *undetectable viral load* and a *CD4 count >200*
True or False. A person with Hep C is not eligible to donate a kidney. - answer-False - can donate but it
will most likely go to a patient who also already has Hep C. Whoever receives it will then go on meds for
Hep C
Where is a transplanted kidney placed? - answer-Placed in the iliac fossa anterior to the iliac crest to
allow easier access to blood supply (original kidneys are not removed)
When should a patient expect urine to begin to flow from a newly transplanted kidney?
,-In the OR
-1 hour post op
-6 hours post op
-Within 24 hours after the surgery is complete - answer--In the OR (indicates the procedure is a success)
ESRD s/s - answer-<5% of kidney function
↓GFR
↑BUN/Creatinine
↑K+ ↓Na+
Anemic (kidneys not producing erythropoetin)
Kidney Transplant complications - answer--Acute tubular necrosis
-Rejection
-Infection
Which of the following is a type of rejection that occurs within 24 to 48 hours?
-acute rejection
-hyperacute rejection
-chronic rejection
-allograft rejection
*BONUS:* How would you treat this? - answer--hyperacute rejection
*Tx:* Immediate removal of the transplanted organ
Which of the following is the most common type of rejection?
-acute rejection
-hyperacute rejection
-chronic rejection
-allograft rejection - answer--acute rejection
,A patient is post op from a kidney transplant 5 days ago. They start complaining of tenderness at the
transplant site and an inability to urinate much. Their creatinine is 2.1 and they have a fever of 101.2F.
What is a likely diagnosis?
-acute rejection
-infection
-hyperacute rejection
-acute tubular necrosis
*BONUS:* How would you treat this? - answer--acute rejection (occurs within a few days to weeks; s/s:
tenderness at site, ↑creat, fever >100, oliguria)
*Tx:* immunosuppressant therapy
Norm Creat = 0.8-1.4
Which of the following are s/s of chronic kidney rejection? Select all that apply.
-Proteinuria
-Oliguria
-K+ of 5.4
-BUN of 8
-Ca+ of 10.9 - answer--Proteinuria
-K+ of 5.4
(+↓Ca ↑K ↑P ↑BUN/Creat +Fatigue - similar to Chronic Renal Failure)
What helps to prevent acute rejection for kidney transplant recipients? - answer-IMMEDIATE
immunosuppressant medications following surgery
Which of the following are risks associated with taking immunosuppressive medications? Select all that
apply.
-tachycardia
-nephrotoxicity
-ototoxicity
, -lanugo
-hypertension
-tremors - answer--nephrotoxicity
-hypertension
-tremors
(+hyperlipidemia +hirsutism +blood dyscrasias +cataracts +gingival hyperplasia +some cancers)
Which of the following is a type of enzyme that activates CD4 T cells?
-Calcineurin
-Amylase
-Calcineurin inhibitor
-Pancreatic lipase - answer--Calcineurin (type of phosphatase)
Following a kidney transplant we want to ________________ the CD4 T cell count with medications that
are _____________________ ____________________. - answer-DECREASE CD4 T cells (which recognize
foreign bodies) with calcineurin inhibitors
Tacrolimus (Prograf) - answer-Immunosuppressant
-*MOA:* inhibits calcineurin (which usually promotes CD4 T cells which activate the immune response
against foreign bodies)
-*Uses:* Prevent rejection
-*S/E:* Nephrotoxicity (↑BUN/Creatinine), Neurotoxicity (tremors, paresthesia), Hyperglycemia,
hyperkalemia, HTN
-*NOTE:* Take on empty stomach, avoid K+ sparing diuretics (spironolactone), avoid grapefruit juice
-*WARNING:* Can cause post transplant diabetes mellitus (causes decreased insulin secretion and
increased insulin resistance)
Which of the following are side effects of tacrolimus? Select all that apply.
-↑BUN/Creatinine
