https://idwiki.org/index.php?action=history&feed=atom&title=Renal_replacement_therapy 2026-04-29T10:07:38Z Revision history for this page on the wiki MediaWiki 1.43.8 https://idwiki.org/index.php?title=Renal_replacement_therapy&diff=4441&oldid=prev 2020-07-04T01:17:54Z

<p>Imported from text file</p> <p><b>New page</b></p><div>* Decision based on patient symptoms and biochemistry<br /> * Often reserved for GFR &amp;lt; 15<br /> * Goal is to avoid crash starts<br /> ** Early referral to nephrologist, pre-dialysis education<br /> ** Selection of RRT modality, establishment of access<br /> ** Higher morbidity, mortality with emergency start<br /> <br /> == Hemodialysis ==<br /> <br /> == Transplant ==<br /> <br /> * Allograft kidney from one person into another<br /> * Patient must be well enough to undergo surgery, must have iliac arteries and such to attach kidney to<br /> * Candidacy<br /> ** ESRD or approaching ESRD<br /> ** Cause of CKD doesn&#039;t matter<br /> * Pre-transplant assessment<br /> ** Risks of procedure<br /> ** Risks of comorbidiities<br /> ** Risks of suppression<br /> ** Risks of rejection<br /> * Pretransplant assessment is extensive<br /> ** CBC, electrolytes, liver, INR/PTT<br /> ** PTH<br /> ** Glucose tolerance test<br /> ** ABO group<br /> ** Serology for CMV, EBV, VZV, HBV, HCV, HIV; not absolute contraindications<br /> ** Possibly serology for &#039;&#039;Schistosomaiasis&#039;&#039;<br /> ** Tuberculin skin test (TBST)<br /> ** CXR<br /> ** Abdominal ultrasound<br /> ** Iliac Dopplers<br /> ** ECG<br /> ** Echocardiogram<br /> ** Cardiac stress test with imaging<br /> ** Age-appropriate cancer screening<br /> ** PRA +/- crossmatch<br /> ** Consult with: transplant coordinator, nephrologist, surgeon, anaesthesia, social worker<br /> ** Consulter:<br /> *** Carotid Dopplers<br /> *** CT iliacs<br /> *** PFTs<br /> <br /> === Types of donors ===<br /> <br /> * Deceased<br /> ** Neurologically deceased<br /> ** Donation after cardiac death<br /> * Living donors<br /> ** Living-related<br /> ** Living-unrelated/emotionally-related<br /> ** Altruistic<br /> * Outcomes are better with living donation<br /> * Waiting time is 6-8 years in GTA<br /> <br /> === Rejection ===<br /> <br /> * Hyperacute<br /> ** Zero risk of this with negative crossmatch<br /> * Most common is T-cell mediated acute cellular rejection<br /> * Also B-cell mediated acute antibody-mediated rejection<br /> * Chronic rejection, usually antibody-mediated<br /> <br /> === Immunosuppression ===<br /> <br /> * Induction with thymoglobulin or basiliximab<br /> * Tacrolimus or cyclosporine<br /> * Mycophenolate (or azathioprine as second-line)<br /> * Prednisone (forever or tapered)<br /> <br /> === Complications ===<br /> <br /> * Graft dysfunction<br /> * Need for longterm immunosuppression<br /> ** Causes HTN, DLD<br /> ** Increased risk of infection<br /> * Bone disease<br /> * Recurrence of original kidney disease<br /> * Graft dysfunction<br /> ** r/o infection like UTI<br /> ** r/o obstruction<br /> ** Medication-related problems<br /> <br /> == Conservative Renal Care ==<br /> <br /> [[Category:Nephrology]]</div>

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