Clinical Judgment - Exam 2 Questions
with All Accurate Answers.
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
-Ototoxicity
-Tremors
-Leukopenia
-Hypertension
-Paresthesia - Answer -↑BUN/Creatinine (*nephrotoxicity*)
-Tremors (*neurotoxicity*)
-Hypertension
-Paresthesia (neurotoxicity)
(+hyperglycemia +hyperkalemia)
What is important patient education to give on someone post-op from a kidney transplant
starting on tacrolimus? - Answer -Take on empty stomach
-Avoid grapefruit juice
-Avoid K+ sparing diuretics
Mycophenolate Mofetil (Cellcept) - Answer Immunosuppressant
-*MOA:* Inhibits T and B cell response, ↓CD8 T cells/ antibodies
-*Uses:* Prevent rejection
with All Accurate Answers.
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
-Ototoxicity
-Tremors
-Leukopenia
-Hypertension
-Paresthesia - Answer -↑BUN/Creatinine (*nephrotoxicity*)
-Tremors (*neurotoxicity*)
-Hypertension
-Paresthesia (neurotoxicity)
(+hyperglycemia +hyperkalemia)
What is important patient education to give on someone post-op from a kidney transplant
starting on tacrolimus? - Answer -Take on empty stomach
-Avoid grapefruit juice
-Avoid K+ sparing diuretics
Mycophenolate Mofetil (Cellcept) - Answer Immunosuppressant
-*MOA:* Inhibits T and B cell response, ↓CD8 T cells/ antibodies
-*Uses:* Prevent rejection
