Examining Renal Transplant patient Flashcards
Peripheral inspection
Renal Impairment
HTN
Pallor
Renal Replacement Therapy
AV fistula (or scar)
Tunnelled dialysis scars
Tenchkhoff catheter scars
Immunosuppressant Stigmata
Cushingoid
Skin tumours: AKs, SCC (100x ↑ risk), BCC and MM
Gingival hypertrophy: ciclosporin
Look for specific causes leading to transplant
DM
Finger pricks from BM monitoring
Insulin marks on abdomen, lipodystrophy
Cystic Kidney Disease
Nephrectomy scars or ballot able kidneys
Connective Tissue Disease
SLE, SS, RA
Inspect abdomen
Rutherford Morrison Scar in RIF
Nephrectomy scars
Tenchkoff catheter scars
Palpate abdomen
Smooth oval mass under scar
Dull PN
Can get below it
Doesn’t move with respiration
Auscultate abdomen
Renal bruit over transplant
Completion
Dipstick: haematuria and proteinuria
Drug chart: any potentially nephrotoxic drug (e.g. ACEi)
BP: HTN common post-Tx
Significant negatives
Evidence of immunosuppression
Signs of a cause: DM and PKD
Working Tx
Renal replacement therapy not in use No pain over Tx site
Gum hypertrophy differential
Drugs: ciclosporin, phenytoin, nifedipine Familial AML Scurvy Pregnancy
Main cause of transplant
DM
GN
Types of transplant
Cadaveric or live
Any complications: e.g. urinary leaks, infection
Current health
Acute rejection: fever, graft pain
Graft function: Cr levels, BP, urine output Immunosuppression
Infection: e.g. CMV pneumonitis
Skin Ca CV risk
Investigations (routine) - urine
Dip - haematuria and proteinuria
MCS
Investigations (routine) - bloods
Bloods
FBC: infection
U+E: eGFR – look @ trend
LFTs: ciclosporin can → hepatic dysfunction
Fasting glucose: tacrolimus is diabetogenic
Drug levels: ciclosporin, tacrolimus
Investigations (routine) - other
Renal biopsy: if rejection suspected
