RENAL

TRANSPLANT
Siti husni binti entoh
790210-12-5522
Sem 1 (0kt / 2016)
Explain contraindication for
transplantation

Explain type of transplant

Preparation pre operative

Post operative care

 Another treatment option for
ESRF patient
Offer patients the best quality of
life
Most cost effective treatment
compared to peritoneal dialysis
and haemodialysis treatment
 HEP / HIV

MALIGNANCY
RECURRENT
DISEASE

DM / SEVERE
PREGNANCY CARDIOVASCULAR
DISEASE

MENTAL
DISORDER HPT
DRUG
ABUSE
LIVING RELATED TRANSPLANT
Donor is from a family member e.g parents,
siblings

LIVING NON-RELATED
TRANSPLANT
Donor is patients spouse or friend

CADAVERIC TRANSPLANT
Kidney is taken from a brain dead pt
Recently died from an accident
DEMOGRAPHIC DATA
NAME : MR A
AGE : 19 YEARS OLD
RACE : MALAY
OCCUPATION : SALESMAN
SMOKER : NON SMOKER
 YOUNGER BROTHER WITH 2
SISTERS
PARENTS STILL ALIVE
STAYING WITH SISTER @ BUKIT
JALIL
FATHER HYPERTENSION, EX
TEACHER
MOTHER FULLY HOUSEWIFE
PRIMARY DIAGNOSIS
ESRF 2 FOCAL SEGMENTAL
GLOMERULOSCLEROSIS
PRE TRANSPLANT (recipient)
POSITIVE CMV, EBV
FACTOR XII DEFICIENCY WITH
PROLONGED PTT
POST CADAVERIC RENAL
TRANSPLANT
 one of the most common causes of
primary glomerular diseases in adults.
The condition causes asymptomatic
proteinuria or nephrotic syndrome with or
without renal insufficiency.
The most common clinical presenting
feature of FSGS (>70% of patients) is
nephrotic syndrome, characterized by
generalized edema, massive proteinuria,
hypoalbuminemia, and hyperlipidemia
 FROM 2005 2007
WAS DIAGNOSED AS
FUNGAL PERITONITIS 2007
REMOVAL OF CATHETER
THEN CONVERT TO
HAEMODIALYSIS TILL THE
END OF 2009
Is a progressive, irreversible deterioration in renal
function

Unable to maintain metabolic, fluid and electrolyte

balance uremia, azotemia

May cause by systemic diseases DM, HPT,

chronic GN, pyelonephritis, hereditary lession
 FUNGAL HAEMODIALYSIS End of 2009
PERITONITIS 2007 transplant
CYTOMEGALOVIRUS (CMV)
common herpesvirus infection easily spread through
sexual & nonsexual contact with body secretions
Cause no symptom

EPSTEIN-BARR VIRUS (EBV)

Common infection occurs in childhood or early
adulthood
Fever, sore throat, swollen lymph nodes
Probably play role in the development of some cancers
 PROTIEN
IN BLOOD

MAY BE AT
RISK OF
FORMING
FACTOR XII PLAY ROLE IN
THE
BLOOD CLOT DEFICIENCY COAGULATION
CASCADE

DOES NOT
LEAD TO
ABNORMAL
BLEEDING
 8TH DEC 2009 TRANSPLANT DONE
@ HKL
LEFT RENAL ALLOGRAFT WAS
TRANSPLANTED INTO LEFT ILIAC
FOSSA
BIOPSY DONE INTRA OPERATIVELY
A FEW LYMPH NODE IN THE
RETROPERITONEAL REGION WHICH
IS REACTIVE HYPERPLASIA
 PRE TRANSPLANT DIALYSIS
CORRECTION OF FLUID & MINIMAL HEPARINISATION
ELECTROLYTE DURING DIALYSIS

IMMEDIATE PRE TRANSPLANT IX

BLOOD , URINE ECG, CXR

PRE OPERATIVE MEDICATION

IMMUNOSUPRESIVE DRUGS
 NURSING
MANAGEMENT
VITAL SIGN
CHECK DIALYSIS HISTORY
ENSURE DRY WEIGHT
ASSESS SIGN OF
OFFER EMOTIONAL INFECTION
SUPPORT
URINE OUTPUT
CONSENT, FASTING,
PROVIDE INFOMATION
BOWERL PREP
 MEDICATION ISOLATION HAND
WASHING

RENAL PROFILE MONITOR CVP,

I/O

INTERNAL J
DAILY IX
STENT

WOUND FLUID
DRAINAGE REPLACEMENT

CBD REMOVED POTASSIUM,

CBD MONITOR
DAY 5 VIT K
 REJECTION OF NEW KIDNEY
HYPER ACUTE REJECTION
ACUTE REJECTION
CHRONIC REJECTION
ALLOGRAFT DYSFUNCTION
URINOMA, CYSTITIS
FOOD POISONING WITH CHRONIC
REJECTION
INFECTION
 u/s done

9/12/2009 no hydronephrosis, no fluid collection, good perfussion

in the entire kidney, no evidence of thrombosis of
transplanted vessels

u/s done
19/1/2010 Slightly dilated tubules, no tubulitis
cushingoid

Admitted due to allograft dysfunction

22/1/2010
Creatinine 113, tacrolimus level height
Iv methylprednisolone for 1 week
Medication Myfortic 360mg bd, aspirin 3 week due to
graft infact (u/s)
11/2/2010 Removal of stent
No other complication detected

c/o pain, fever, swelling rt iliac fossa

18/2/2010
Admitted due to developed urinoma
Pigtail drainage inserted 3/7, then CBD ESBL
Klebsiella UTI, antibiotic started
u/s revealed hydronephrosis & thickened uretherlid

1/3/2010 Cystogram done, result showed, smooth bladder outline,

cannot tolerate capacity more then 70cc
 TCA clinic
cushingoid

18/3/2010


Weight 36.3kg
Creatinine and tacrolimus within normal range
Residual urine scan 0cc.

Admitted with c/o fever, headache, nausea, cough 1/7

11/2/2011
Bp 128/84mmHg
Blood ix done, total white 11.0
Med PCM
Impression : viral fever

24- Admitted with c/o hematuria 3/7

IV cefuroxime completed for 1week

28/9/2012 Impression : cyctitis


25-
Admitted with c/o headache 3/7 a/w vomiting
BP 102/55mmHg
HPT drug stopped
27/9/2013 Diagnosed as Hypotension

23- Admitted with diagnosed as 1- food poisoning ( likely) 2-

post renal transplant rejection
c/o vomiting 4,5 times, contains foods particle,
25/10/2014 abdominal pain, loose stool
h/o taken outside food
LOWER EXTRIMITIES
SUMMARY OF PHYSICAL EXAMINATION
No pedal edema
Capillary refill less than 2 sec
GENERAL CONDITION
Alert
Concsious
NECK
No cushingoid
No jugular vein
distended
LUNGS
No creps
CARDIOVASCULAR Good air entry
S1S2 no murmur

ABDOMEN
Graft scar at right illac
fossa region
No tender
Active peristalsis
activity GASTROINTERSTINAL
Peritoneal dialysis scar TRACK
Abdomen pain Abdominal pain
Loose stool
GENETALIA Vomiting contains foods
Able to passing urine with large amount particles
No hematuria no dysuria No blood or mucus
contain

LOWER EXTRIMITIES
No pedal edema
Capillary refill less than 2 sec
AMLODIPINE ATENOLOL 50MG MYCOPHENOLATE
10MG OD OD 360MG

ROCALTRIOL COTRIMAXAZOLE
SLOW K I/I OD
0.25MCG OD 480MG ON

TACROLIMUS DILTIAZEM 30MG PREDNISOLONE

1.5MG BD BD 7.5MG OD
PROBLEM
1- Abdominal pain due to food poisoning
objective - pain reduced
2- Dehydration due to vomiting and diarrhea
objective - no dehydration
3- Potential of allograft dysfunction due to post surgery
objective - allograft functioning well
4- Potential of chronic rejection of renal transplant
objective - sign and symptom of chronic rejection aware by client
5- Potential of recurrent cystitis underlying renal transplant
objective - no recurrent of cystitis
6- Potential of recurrent hypotension due to medication
objective - no recurrent of hypotension