ESRD
CC: examine abdomen
Diagnosis:
ESRD
Clinical signs:
Neck scar
Arm: AV fistula
Peritoneal dialysis scars: below ( insertion site ) or lateral ( exit site ) to umbilicus
Abdomen: iliac fossa scar for kidney transplant or flank scar for nephrectomy ( polycystic kidney, renal cancer )
Central line fixed in neck Hand tremor
Multiple violaceous بنفسجي plaques ( kaposi sarcoma or drug side effects )
Differential diagnosis of top causes for renal transplant:
Glomerulonephritis
Diabetic nephropathy
Polycystic kidney disease ( ADPKD
Area to examine ?
Abdomen
Check leg edema
Check for tremor ( tacrolimus )
Examine lymph nodes
Look for fistula, neck scar
Causes of renal failure:
Diabetes
Polycystic kidney
Systemic sclerosis
Rheumatoid arthritis
Tuberous sclerosis
amyloidosis
Calcineurin inhibitor nephrotoxicity
Extra:
Steroid : cushioned appearance
Tacrolimus: fine tremor
Ciclosporin: gum hypertrophy
Both cyclosporin & tacrolimus: hypertension
Both ciclosporin & azathioprine: skin damage & malignancy
Treatment modalities ,hints ?
Hemodialysis : fistula, AV graft,, tunneled neck lines
Peritoneal dialysis: abdominal catheter
Transplant: no evidence of dialysis access., or central line fixed in neck indicating failure of transplanted kidney and patient receiving dialysis through CV line
Problems following transplant ?
Rejection: acute or chronic
Infection: CMV, pneumocystis carinii
Skin malignancy
Post-transplant lymphoproliferative disease
Hypertension & hyperlipidemia causing cardiovascular disease
Drugs side effects
Recurrence of original disease
Chronic graft dysfunction
Success of renal transplant?
50% 10-year graft survival ( better with live-related donor grafts )
