CCTN Kidney Transplant
Questions with Accurate Answers
Define acute tubular necrosis and explain how it is managed. correct answer ATN
is death of the kidney tubule cells that transport urine to the ureters. ATN is
characterized by cessation of urine output (anuria) or by scant urine output
(oliguria) ranging in duration from a few days to several weeks. The GFR declines
and BUN and creatinine levels rise. Known risk factors that contribute to ATN are:
aging, cold ischemic time greater than 24 hours, hemodynamic instability pre-
transplant, toxic reaction to the suspension used to flush the kidneys, and kidney
sepsis from improper cleansing. ATN is treated with a monoclonal or polyclonal
antibody. While antibody treatment is underway, withhold the CNI because it
increases the patient's risk of nephrotoxicity. If ATN persists longer than a week
post-transplant, suggest to the attending physician that a tissue biopsy should be
performed, to rule out organ rejection.
Describe when rejection can be identified in a pancreas-kidney recipient. correct
answer With an SPK transplant recipient, the transplanted kidney is frequently the
first to become involved in the rejection process. The first signs of kidney
rejection are: a rapid increase in serum creatinine levels; transplant site pain; and
elevated temperature. A biopsy tissue sample must be taken before initiating
treatment for organ rejection. If the biopsy sample confirms rejection, it is
assumed that the recipient is rejecting both organs. However, SPK biopsies are so
difficult that they are usually deferred until it is too late.
As with pancreas transplants, SPK transplants do not produce elevated blood
glucose levels until the pancreatic islet cells are already in the process of being
destroyed.
Discuss lymphoceles and urine leaks as post-renal transplant complications.
correct answer A lymphocele is an accumulation of lymphatic fluid around the
, transplanted kidney because blood vessels were tied off poorly during surgery
(ligation). S/s of lymphoceles include: frequency and urgency, pain and
tenderness, and incontinence as a result of pressure from the lymphocele. The
iliac vein can also develop an obstruction, resulting in swelling of the leg.
Lymphoceles are diagnosed through US.
Urine leaks are due to a reconnection problem with the blood vessels serving the
ureters and bladder, but can be mistaken for organ rejection. A yellow, serous
drainage may be seen if the patient's urine output is acceptable. Collect a sample
of the drainage for creatinine analysis. A significantly high creatinine level can
indicate a urine leak. A small leak can be fixed by decompression of the bladder
with a catheter. If the problem persists, surgery will be necessary.
Discuss the advice that should be given to the post-operative kidney transplant
recipient concerning sex and pregnancy. correct answer All adult recipients:
Resume sexual activity when the incision has healed, and you and your partner
feel comfortable with sex. Don't put pressure on the dialysis access site. If you
have self-image issues because of surgical scars and drug side effects, we can
arrange sex therapy. You may have had sexual problems before your surgery
because of high blood pressure and anemia. Fertility and libido usually return to
normal within a few weeks. Steroid side-effects, impotence, and vaginal dryness
are certainly treatable.
Teenagers:
Dialysis may have made the patient smaller than their peers, and less sexually
mature. The transplant will help resolve these issues.
Explain if kidney transplant recipients should be given the flue vaccine and what
precautions need to be taken regarding live vaccines. correct answer All kidney
transplant recipients need to be vaccinated against influenza in mid-October
Questions with Accurate Answers
Define acute tubular necrosis and explain how it is managed. correct answer ATN
is death of the kidney tubule cells that transport urine to the ureters. ATN is
characterized by cessation of urine output (anuria) or by scant urine output
(oliguria) ranging in duration from a few days to several weeks. The GFR declines
and BUN and creatinine levels rise. Known risk factors that contribute to ATN are:
aging, cold ischemic time greater than 24 hours, hemodynamic instability pre-
transplant, toxic reaction to the suspension used to flush the kidneys, and kidney
sepsis from improper cleansing. ATN is treated with a monoclonal or polyclonal
antibody. While antibody treatment is underway, withhold the CNI because it
increases the patient's risk of nephrotoxicity. If ATN persists longer than a week
post-transplant, suggest to the attending physician that a tissue biopsy should be
performed, to rule out organ rejection.
Describe when rejection can be identified in a pancreas-kidney recipient. correct
answer With an SPK transplant recipient, the transplanted kidney is frequently the
first to become involved in the rejection process. The first signs of kidney
rejection are: a rapid increase in serum creatinine levels; transplant site pain; and
elevated temperature. A biopsy tissue sample must be taken before initiating
treatment for organ rejection. If the biopsy sample confirms rejection, it is
assumed that the recipient is rejecting both organs. However, SPK biopsies are so
difficult that they are usually deferred until it is too late.
As with pancreas transplants, SPK transplants do not produce elevated blood
glucose levels until the pancreatic islet cells are already in the process of being
destroyed.
Discuss lymphoceles and urine leaks as post-renal transplant complications.
correct answer A lymphocele is an accumulation of lymphatic fluid around the
, transplanted kidney because blood vessels were tied off poorly during surgery
(ligation). S/s of lymphoceles include: frequency and urgency, pain and
tenderness, and incontinence as a result of pressure from the lymphocele. The
iliac vein can also develop an obstruction, resulting in swelling of the leg.
Lymphoceles are diagnosed through US.
Urine leaks are due to a reconnection problem with the blood vessels serving the
ureters and bladder, but can be mistaken for organ rejection. A yellow, serous
drainage may be seen if the patient's urine output is acceptable. Collect a sample
of the drainage for creatinine analysis. A significantly high creatinine level can
indicate a urine leak. A small leak can be fixed by decompression of the bladder
with a catheter. If the problem persists, surgery will be necessary.
Discuss the advice that should be given to the post-operative kidney transplant
recipient concerning sex and pregnancy. correct answer All adult recipients:
Resume sexual activity when the incision has healed, and you and your partner
feel comfortable with sex. Don't put pressure on the dialysis access site. If you
have self-image issues because of surgical scars and drug side effects, we can
arrange sex therapy. You may have had sexual problems before your surgery
because of high blood pressure and anemia. Fertility and libido usually return to
normal within a few weeks. Steroid side-effects, impotence, and vaginal dryness
are certainly treatable.
Teenagers:
Dialysis may have made the patient smaller than their peers, and less sexually
mature. The transplant will help resolve these issues.
Explain if kidney transplant recipients should be given the flue vaccine and what
precautions need to be taken regarding live vaccines. correct answer All kidney
transplant recipients need to be vaccinated against influenza in mid-October
