Kidney Transplantation (Renal Transplantation) Auto Saved]

8/3/2019 Kidney Transplantation (Renal Transplantation) Auto Saved]

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KIDNEY

TRANSPLANTATION

PRESENTER: MODERATOR:

DAINY THOMAS MADAM RACHELANDREWS

MSc NURSING IST YEAR STUDENT, LECTURER,

AIIMS. AIIMS.


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INTRODUCTIONINTRODUCTION

Organ transplant of a kidney into a

patient with end- stage renal disease.

Typically classified as deceased-

donor (formerly known as cadaveric)

or living-donor transplantation


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INTRODUCTIONINTRODUCTION

It is the most cost

effective

treatment methodfor ESRD.


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KIDNEY TRANSPLANTATIONKIDNEY TRANSPLANTATION

Living-donor renal transplants:

Genetically related (living-related)

Non-related (living-unrelated)

transplants, depending on whether a

biological relationship exists between the

donor and recipient.


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Donor kidneyDonor kidney--placed inferior of the normalplaced inferior of the normal

anatomical location.anatomical location.


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y First human to human transplant done in

1936, from a B+ cadaver to O+ recipient.

y First cadaveric kidney transplantation in

the United States 1950- polycystic

kidney disease, at Illinois.

y The first kidney transplants between

living patients -1954 (Boston and Paris).

HISTORYHISTORY


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HISTORY (CONTD)HISTORY (CONTD)

y The procedure was done between identical

twins to eliminate any problems of an

immune reaction.

y Dr. Murray received - Nobel Prize for

Medicine(1990).


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ADVANTAGESADVANTAGES

The kidney - easiest organ to transplant:

Tissue typing - simple.

Organ - relatively easy to remove and

implant.Live donors could be used without

difficulty.

In the event of failure, dialysis wasavailable from the 1940s.


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INDICATIONS FOR KTPINDICATIONS FOR KTP

y End-Stage Renal Disease (ESRD),

regardless of the primary cause.

y ESRD is defined as a drop in

the glomerular filtratration rate (GFR)


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CONTRAINDICATIONSCONTRAINDICATIONS

y MALIGNANCY

y RECURRENT DISEASES

y INFECTION

y HIGH PROBABILITY OF POST OPERATIVE

MORBIDITY& MORTALITY

y NONCOMPLIANCE


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Contraindications for KTPContraindications for KTP

Cardiac and pulmonary insufficiency,

Hepatic disease

Incurable terminal infectious diseases

Morbid obesity

Psychiatric illness and/or significant on-

going substance abuse issues.


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SOURCES OF KIDNEY

Depending on the source of the recipient

organ.

y Living-donor transplantation

Genetically related (living-related)

Non-related (living-unrelated)


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SOURCES(Contd)

y Deceased-donor (formerly known as

cadaveric).

Brain-dead (BD) donors or ("heart-

beating): Donor's heart continues to

pump and maintain the circulation.

Donation after Cardiac

Death (DCD):

Have elected via a living will or through

family to withdraw support.


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PAIRED KIDNEY DONATIONPAIRED KIDNEY DONATION

y It is an option for

patients in need of a

kidney transplant who

have a living donor

whose blood or tissue

type is not compatible.

y

Known as KIDN

EYSWAPING


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Recipient evaluation processRecipient evaluation process

y Early referral : as soon as CKD is diagnosed.

y Patient education

y Age

yPolycystic kidneys

y Urinary tract

y Cardiac disease evaluation

y GIT evaluation

y Respiratory disease evaluationy Obesity

y Oral hygiene


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Benefits of a renalBenefits of a renal

transplantationtransplantationy Improved quality of life

y Freedom from dialysis

y Normal healthy diet

y Freedom from liquid restriction

y

Travel freelyy Employment

y Improved fertility


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PRE TRANSPLANTATIONPRE TRANSPLANTATIONPREPARATIONPREPARATION

STAGE 1:STAGE 1: Information and discussionInformation and discussion

Desire to receive a transplantDesire to receive a transplant

Benefits of a renal transplantBenefits of a renal transplant

Risks/ disadvantages of a renal transplantRisks/ disadvantages of a renal transplant

STAGE 2 :STAGE 2 : Clinical assessmentClinical assessment

Clinical historyClinical history

Renal disease & disease progression; dialysisRenal disease & disease progression; dialysis

statusstatus


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Pre transplantation prep.Pre transplantation prep.

STA

GE 2:

Previous medical history: BT, pregnancy,

surgery

Current clinical status

Social history& family status

Personal history: smoking , alcohol, drug abuse

Current medication, allergies, blood group

System wise assessment


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Pre transplantation prepPre transplantation prep

y Information: discussion

x Risks

x Further investigation

x Living donor or cadaveric list

x Immuno suppression regimen

x Decision


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y Stage 3 : Routine Investigations

Blood group

Tissue typing

Biochemistry

Haematology

Liver function tests

Lipid level


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Pre transplantation prepPre transplantation prep

Virology:Hep B &C, HIV, CMV

Chest X- ray, ECG

Mid stream urine

Specific investigation required

y STAGE 4 :

Orientation, Final cross match


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DONOR AND RECIPIENTDONOR AND RECIPIENT

MATCHINGMATCHING

y ABO Blood group

y Major histocompatibility complex (human leukocyte

antigen): Two major types: class 1& class 2

Class 1: HLAA, HLAB,HLAC

Class 2: HLADP, HLADQ, HLADR

A,B,C & DR - 4 Main series important for

transplantation

y Pre transplant cross matching


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Pre transplant cross- match

y Blood sample of recipient +

lymphocytes from the donor.

y If donors cell die, its a +ve cross match

y i.e. recipient is adversely reacting to

donors antigens, so the transplantationwould be rejected.


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SensitizationSensitization

y It is defined as being immunized, or able to

mount an immune response, against an

antigen by previous exposure to that antigen.

Desensitization

y IVIG (2g/kg)

y IVIG + Plasmapheresis


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Research input

yA comparison of the results of renal transplantation fromnon-heart-beating, conventional cadaveric, and living

donors.

y Nicholson ML et al

y Kidney Int. 2000 Dec;58(6):2585-91

y The initial function rates forNHBD, HBD, and LD

transplants were 6.5, 76.3, 93% respectively .Despite being

associated with poor initial graft function, the long-term

allograft survival ofNHBD kidneys does not differ

significantly from the results ofHBD and LD transplants.


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KIDNEY HARVESTINGKIDNEY HARVESTING

From a living donor: Steps

1.Assessment & preparation for donation:

Donor & recipient matching.

Informed consent

Physical and clinical examination

2.Investigations

3.Assessment of surgical risk: Is donation safe for the

recipient & donor ?

4.Preoperative assessment


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ASSESSMENT ANDASSESSMENT AND

PREPARATION OF DONORSPREPARATION OF DONORS

THREE STAGES

y STAGE 1:Assessment

1.Age2.Informed consent

3.Preliminary medical history

4.Renal disease5.Smoking, Drug or alcohol abuse

6.Obesity


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Stage 2: Donor blood clinicalStage 2: Donor blood clinical

teststestsy Blood group

y Tissue typing: T cell &B cell cross match

y Urea ,electrolytes & creatinine

y LFT, fasting glucose

y Hemoglobin & clotting screen

y Viral screen

y Urine tests

y B. P, pulse, weight ,height


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Investigations : 2nd stageInvestigations : 2nd stage

y Done prior to medical assessmenty Blood tests: repeat tissue typing, LFT,

hematology

y

Clinical tests: chest X-ray, ECG, USG of renalsystem

y Urine tests:

Midstream urine,

Urinalysis: proteinuria, hematuria

Assess GFR: 24hr urine for creatinine

clearance, clearance scan.


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Stage 3: Medical AssessmentStage 3: Medical Assessment

y Is donation safe for recipient?

yIs donor fit for a nephrectomy?

yCan donor afford the gift?


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Preoperative Assessment Of bothPreoperative Assessment Of both

donor and recipientdonor and recipient

y Final cross matching & tissue typing

y Methicillin-resistant swabs for Staph.

aureus( throat, nose, axilla, groin)

y Mid stream urine, urinalysis

y Biochemistry,LFT, Hematology,clotting

system


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CONTD

yECG, BP, Pulse, Temperature,Chest

X ray

yOrientation to the unit.

y Final cross- match.

y Pre post op. care.


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CADAVERIC DONATIONCADAVERIC DONATION

Cadaveric donors are patients who sufferedirreversible brain stem damage.

Criteria for multiple organ donationCriteria for multiple organ donation

Patient:Patient:yy Is aged between 18monthsIs aged between 18months--80 years80 years

yy Has suffered irreversible brain damageHas suffered irreversible brain damage

yy Is maintained on a ventilatorIs maintained on a ventilatoryy Has no major untreated sepsisHas no major untreated sepsis

yy Is HIV,Is HIV, HepHep B&C negativeB&C negative


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LIVING DONORSLIVING DONORS

EXCLUSION CRITERIA

y Cognitive deficit

y Active drug or alcohol abuse

y Evidence of renal disease ( low GFR,

proteinuria, abnormal renal anatomy)

y Diabetes , hypertension, CAD

y Active infection, chronic viral

infection(Hep B, Hep C)

y Current/history of neoplasm, family

history of any renal cell cancer

y Current pregnancy


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Surgical technique for livingSurgical technique for living

donor nephrectomydonor nephrectomy

Two approaches:

flank incision with

y Rib resectingy Supra costal approach


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Surgical techniques forSurgical techniques for

nephrectomynephrectomy

yTrans abdominal

yLaparoscopic

y Single port access surgery

yNatural orifice Transluminalendoscopic surgery


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Kidney harvestingKidney harvesting


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Transplantation OperationTransplantation Operation

y In most cases the barely functioning existing

kidneys are not removed.

yThe new kidney is placed in the iliac fossa.

Right side regardless of the side origin

from donor.

Contralateral side to the side of donor.

Ipsilateral side to the donor kidney.


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ContCont

y Its blood vessels connected to arteries and

veins in the recipient's body i.e.,

Renal artery of the kidney, is often

connected to the external iliac artery inthe recipient.

Renal vein of the new kidney, is often

connected to the external iliac vein in therecipient.


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ContCont


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Kidney preservationKidney preservation

1.Cold storage method:

y Suitable upto 30hrs of preservation.

2.Machine perfusion

y Suitable upto 48 hrs.


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Solutions used forSolutions used for

preservationpreservation

y Collins solution.

y University of Wisconsin

solution

y HTK- Custodial

solution


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HTK SolutionHTK Solution

y HTK(Histidine-

Tryptophan-

Ketoglutarate)

Solution.y HTK is perfused as a

cold solution, so that

its hypothermic

effect contributes to adecreased metabolic

rate.


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ContdContd

y Surgery lasts five hours on average.

y Living donor kidneys normally require

35 days to reach normal functioning

levels.

y Cadaveric donations stretch that interval

to 715 days.

y Hospital stay is typically for 47 days.


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Indications forIndications for pretransplantationpretransplantation

native nephrectomynative nephrectomy

Chronic renalChronic renal parenchymalparenchymal infections.infections.

Infected stonesInfected stones

HeavyHeavy ProteinuriaProteinuria

Intractable hypertensionIntractable hypertension

Polycystic kidney diseasePolycystic kidney disease

Acquired renal cystic diseaseAcquired renal cystic disease

Infected refluxInfected reflux


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Postoperative management:Postoperative management:

living donorliving donor

y Hydration: fluid & electrolyte balance

IV hydration for first 24- 48 hrs

monitoring of fluid & electrolyte balance

intake output monitoring

y Wound management- Regular inspection -

bleeding and infection

y Emotional support

y Discharge


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PostPost--opop MxMx of donorsof donors

y Check vital signs.

y Input/ output charting

y Get a Chest -X-ray to exclude any

pneumothorax

y Early ambulation

y Administer analgesics as prescribed


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y Can eat 24-48 hrs post-op.

y Wound management

y Complete recovery takes about 6-8 wks.

y Educate the donor for some lifestyle

changes for risk modification.

PostPost--opop MxMx of donorsof donors


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PostPost-- Op Nursing CareOp Nursing Care

Vital signs every 1hr for 24 hrs, then every

4hrs.

I/O every hr for 24 hrs.

Intravenous fluids as prescribed

Daily weight

Turn, cough, deep breathing, intensive

spirometry.


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Dressing changes, palpate fistula every 4 hr.

No BP or venipuncture in extremity with

fistula.

Catheter care and irrigation

Notify if urine output


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COMMONLY GIVENFLUIDSCOMMONLY GIVENFLUIDS

y Types of fluids

y 5% dextrose RingerLactate NS

y Amount of fluid to be given

Output less than 50ml/hr : inform

Output 50- 200ml/hr: output+150ml

Output 200-400ml/hr: output amount

Output 400-500ml/hr:400ml of fluid

Post operativePost operative


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y For a delayed functioning graft

y Intravenous fluids- maintain CVP 10-15

cm water & frusemide to induce diuresis

y Serum electrolytes: any disturbances

warrant immediate attention

Post operativePost operative

management..management..


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Post op management ofPost op management of

recipientrecipienty Immunosuppressant drugs are must for

good outcome.

y Most common medication are

Calcineurin inhibitors: Tacrolimus or

cyclosporine

Mycophenolate mofetil andAzathioprine

Corticosteroids: prednisolone IVIG


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Uses ofUses of immunoglobulinsimmunoglobulins

y To reduce high levels of preformed anti-

HLA antibodies in sensitized patients.

y To facilitate living donor transplants in

case of +ve cross-match orABO

incompatibility.

y To treat acute rejection.

y To treat certain post transplant viralinfection.


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Post operative management..Post operative management..

Tubes and drains

catheter removal: in the first week

Closed suction drain removal: when output

decreases to


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1.Renal transplant rejection1.Renal transplant rejection

Three types:

yHyper acute rejection

yAcute rejection

yChronic rejection


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HYPER ACUTE REJECTION

Occurs immediately in the operating room, when thegraft becomes mottled and cyanotic.

Causes:previous exposure to the donor antigens.

As in:

Previous rejected kidney transplant.

Multiparous women.

Previous blood transfusion.

Prognosis: kidney removal


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HYPER ACUTE REJECTION


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ACUTE REJECTION

Appears within the first 3 post transplant

months.

Affects 30% of cadaveric transplants and 27%

of transplants from living donors.

20% of patients with transplants experience

recurrent rejection episodes.

S


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SIGNS AND SYMPTOMS

Decreasing urine output

Hypertension, rising creatinine

Mild leukocytosis

Fever

Graft swelling

Pain

Tenderness may be observed

Final diagnosis depends upon a graft biopsy


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y Investigations

Radio isotope renography

Ultra sound

Urine culture and sensitivity

Needle biopsy

yTreatment: high dose pulses ofglucocorticoids

ACUTE REJECTIONACUTE REJECTION


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ManagementManagement

1.High dose corticosteroids

.

2.Repeated.

3.Triple therapy.

a) Corticosteroids

b) Calcineurin inhibitor.c) Antiproliferative agents

4. Plasmapheresis

Not enough

Not enough


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CHRONIC REJECTIONCHRONIC REJECTION

yGradual decline in renal function

associated with interstitial fibrosis

& vascular changes

yFactors associated with chronic

rejection are both immunological +non-immunological


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ManagementManagement

y Irreversible & cannot be prevented.

y Only treatment is a new transplant

after 10 years


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2.Acute occlusion of transplant renal

artery or vein.y Occurs in first transplant week (0.5-8%).

y Causes oligo/anuria andARF.

y

With renal vein thrombosis, graft tenderness,darkHematuria and decreased urine volume.

y Diagnosis is via doppler ultrasound or

radioisotope scanning to demonstrate lack of

blood flow.y Treatment is surgery.


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3.Peritransplant haematoma

y Early post- op complication

y Severe pain over allograft, decreased Hb

orHct, increased serum creatinine.

y Recurrent increased K+ due to lysis ofRBC in haematoma.

y Diagnosis via USG or CT.

y Treatment is surgical and usually leads toallograft nephrectomy.


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4.Urinary Leak

y First transplant month. (2-5%)

y Patient presents with urine extravasation and

ARF, fever, pain and distended abdomen.

y Diagnosis is via ultrasound which demonstrates

a peri-transplant fluid collection or via

radioisotope scanning.

y Treatment is foleys catheter insertion and

surgery.

5 Lymphocoele


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5.Lymphocoele

y Occurs within the first 3 post transplant

months and is due to lymph leaking frominjured lymphatics (5-15%).

y It causes:

Pain

ARF Ipsi-lateral lower extremity oedema,

Occasionally iliac vein thrombosis. Most ofthe signs and symptoms are due to pressure

effects.

y Diagnosis - ultrasound.

y Treatment- percutaneous drainage.

6 Ob t ti U th


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6.Obstructive Uropathy

y Occurs in early post transplant period (3-

6%).y Causes are:

extrinsic compression of the ureter by a

lymphocoele a technical problem with the ureteric

anastomosis to the bladder.

yDiagnosis - ultrasound demonstratinghydronephrosis.

y Treatment is surgical.


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7.Renal artery stenosis

y Late presentation.

y Patients present with uncontrolled HT,

allograft dysfunction and peripheral

oedema.

y Diagnosis is via ultrasound or MRA.


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8.Post-transplant lymphoproliferative

disorder.

9.Imbalances in electrolytes.

10. Infections and sepsis due to the

immunosuppressant drugs that are

required to decrease risk of rejection.


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11. Malignancy11. Malignancy

y Transplant recipients are at significantlyhigher risk for cancers than the generalpopulation because of

(1) ChronicImmunosuppression,

(2) Chronic antigenic stimulation,

(3) Increased susceptibility to oncogenicviral infections, and

(4) Direct neoplastic action ofimmunosuppressants.


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ImmunoImmuno suppressionsuppressiony Combination of drugs are given:

Triple drug regimen

y a glucocorticoid ; eg; prednisolone

y a calcineurine inhibitor ,e.g; cyclosporine, tacrolimus

y a purine antagonist, eg; azathioprine

ormycophenolate mofetil + antilymphocyte antibody,eg ;OKT3

M t i iM t i i


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Most common immunosuppressiveMost common immunosuppressive

protocolsprotocols

1.Cyclosporin/MMF/steroids

2.Tacrolimus/MMF/steroids

3. Cyclosporin/sirolimus/steroids

4. Tacrolimus/sirolimus/steroids

ImmunosuppressiveImmunosuppressive


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ImmunosuppressiveImmunosuppressive

medicationsmedicationsy The calcineurin inhibitors

Eg: cyclosporine , tacrolimus

MOA: formation of a complex with their

respective cytoplasmic receptor proteins. This

complex binds with calcineurin. Inhibition of

calcineurin impairs the expression of several

critical cytokine genes; eg:IL-2,IL-4, interferon

and tumor necrosis factor

ImmunoImmuno suppressive medicationsuppressive medication


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calcineurincalcineurin contconty Drug is primarily excreted through bile.

y Drug level monitoring

y Drug interactions

Drug concentration decreases with

x Rifampin,

x Barbiturates, phenytoin

Drug concentration increases with

x Calcium channel blockers

x Antifungal agents



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calcineurincalcineurin contconty Side effects ofcyclosporin

Nephrotoxicity: decreased GFR

Hypertension

Hepatic dysfunction

Hirsutism, hypertrichosis

Hyperlipidaemia

Hyperkalemia, hypomagnesemia

Hyperuricemia

Gum hypertrophy



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CalcineurinCalcineurin contcont

y Side effect of Tacrolimus

Visual and neurological disturbances

Hypertension

Tremor, headache, insomnia

Raised blood sugar level

Leukopenia


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ImmunoImmuno suppressive .suppressive .y Mycophenolate mofetil

Mechanism of action:

x Reverse inhibitor of enzyme inosine

monophosphate dehydrogenase.

Side effects

x Diarrhoea

x Vomitingx leukopenia

ImmunoImmuno suppressivesuppressive


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ImmunoImmuno suppressivesuppressivey Azathioprine

Mechanism of action

x Inhibits both DNA& RNA synthesis and prevents

growth of lymphocytes

Side effects

x Neutropenia (main)

x Alopecia

x Muscular pains

x Malignancy

x Altered liver function

x Pancreatitis , cholestatic jaundice (rare)



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y Prednisolone


x Antiinflammatory responses with blocking of T cell

and interleukin-1

Side effects:

x Cushingoid appearance (facial swelling)

x Fluid retention

x Glaucoma

xIncreased appetite, peptic ulcer

x Hypertension, increased blood sugar level

x Psychosis , mood swings



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ImmunoImmuno suppressivesuppressivey Orthoclone(OKT3) monoclonal antibody

y Mechanism of action:

x React with CD-3 molecules on the lymphocytes and depletes

them.

y Side effects:

x Chest pain

x Pulmonary edema

x Gastrointestinal disturbances

x Fever with Chills

x Dyspnoea

x Infections


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ImmunoImmuno suppressive..suppressive.. Antilymphocyte globulin- polyclonal antibody


Inhibits and destroy circulatory lymphocytes through

antibody action

Side effects:

Rash

Fever with chills

Anaphylaxis

Thrombocytopenia, leukopenia

Myalgia


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Nursing Management.Nursing Management.

1. Assessing the patient for transplant rejection.

2. Preventing infections

3. Monitoring urinary functions

4. Providing psychological support to the patient &

family.

5. Monitoring & managing potential complications.

6. Patient & family education.

Post operative nursingPost operative nursing


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Post operative nursingPost operative nursing

managementmanagement

Ineffective airway clearance related to depressed

respiratory function, pain, and bed rest

Close monitoring of respiratory status

Assess respiratory pattern, auscultate for any

crackles or abnormal respiratory sounds

Early chest physiotherapy Encourage to do deep breathing& breathing

exercises


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Nursing managementNursing management

Acute pain related to surgical incision

Assess pain : patterns, any radiating pain

Administer analgesics as prescribed

Non pharmacological measures -

distraction , imagery, relaxation etc can be

used to supplement medication.


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Risk for fluid and electrolyte imbalance related

to the post operative condition

Assess CVP and urinary output frequently

Hourly intake equal to previous hours output plus

50ml

Monitoring of serum biochemistry and hemoglobin

frequently

Oral fluids usually introduced in early post

operative period as paralytic ileus is rare

N i tN i t


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y Risk for rejection of graft

Assessing the patient for transplantation rejection :

oliguria, edema , fever, increase BP, weight gain,

and swelling or tenderness over graft.

Those who receive cyclosporine the only sign may

be asymptomatic rise of serum creatinine >20% is

considered as acute rejection.

Differentiate between infection and rejection.


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Potential for developing infection related to the

immuno suppressed state

Assess for Signs and symptoms of infection

Protect patient from exposure to infection: carefulhand hygiene& use of personal protective

equipment

Meticulous catheter care.

Urine cultures, wound drainage culture, catheter tip

culture etc.


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Research inputResearch input

Cytomegalovirus infection renal transplantrecipients: risk factors and outcome.

Kanter J, Pallard L, et al

Transplant Proc. 2009 Jul-Aug;41(6):2156-8

Recipient age older than 55 years, induction therapywith Thymoglobulin, and maintenance immuno

suppression with cyclosporine were the major risk

factors to develop CMV disease. Data showed that CMV

is a common complication after kidney transplantationassociated with older age, induction treatment with

antilymphocyte globulin, worse renal function, and

increased patient morbidity.


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Monitoring and managing potential

complications

Assess for complications related to renal failure .

Assess for GI ulceration& bleeding related to

corticosteroid therapy

Monitor closely for signs and symptoms of

adrenal insufficiency


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NURSING MANAGEMENTNURSING MANAGEMENT

Pre operative teaching include:

Post operative pulmonary hygiene

Pain management options

Dietary restrictions Presence of indwelling catheters & IV &arterial

lines

Psychological concerns


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Promoting home based carePromoting home based care

Teach patient self care

Educate them about the need for continuing

immunosuppressive therapy.

Instruct family members to assess for signs

and symptoms of transplant rejection,

infection, & potential adverse effect of

immunosuppressant medication.


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Promoting home care.Promoting home care.

Continuing care

Explain the patient need for life long follow up

care.

Individual verbal & written instructions to be

provided to the patient concerning various

aspects.

Watch for malignancy as the patient is receiving

long term immunosuppressive therapy.


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Post transplant diet restrictionsPost transplant diet restrictions

Variety of foods

Limit sodium, saturated fat and cholesterol intake

Monitor weight on a daily basis

Avoid sugary snacks between meals

Eat 1000- 1500mg calcium daily

Regular exercise 30 mins at least 3 times a week Drink plenty of fluids 3 to 4 litres per day


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BehaviourBehaviour modificationmodification

Eating slowly

Have regular meal patterns with frequent interval

Dont skip breakfast.

Last meal should be taken around 8.30pm

Dont sleep immediately after taking meal

Eat always in pleasant atmosphere. Eat always in sitting down position


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Food hygieneFood hygiene

Raw vegetables should be washed properly

Dont cut vegetables until just before cooking

Dont overcook vegetables

Oil or ghee should not be reused

Cook food hygienically and freshly prepared

Dont eat uncooked foods and avoid eating out

Take only boiled water.


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In post-transplant

patient

P i 1 3 2 0 /k b d


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y Proteins: 1.3 to 2.0 g/kg body wt.

y Calories: 30- 35 kcal/kg

y Carbohydrates: 50% -70% of all calories.y Fat: 35% of calories.

y Sodium:

for normotensive= no restrictions otherwise,

restricted to 2g/day.y K+ : restricted in hyperkalemia

y Fluid:

normo-volumic = 2000ml/day

oliguric: urine output + ~500ml/day

R i l i i iR i l i i i


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Resuming normal activitiesResuming normal activities

Pregnancy

Work

Traveling

Dental care

Skin care

Exercise Vaccinations

A idi i f iA idi i f i


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Avoiding infectionAvoiding infection

Wash hands often

Stay away from people with cold or other infections

Screen visitors for infection

Wash hands after coughing and sneezing.

Avoid live vaccines such as polio, mumps..

Do proper dental care. Avoid contact with animals that roam outside

Si t t h t f


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Signs to watch out for

Fever

Shortness of breath

Cough

Skin changes

Pain or discomfort during micturation

Decrease in urine output, hematuria


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Clinic visits

Upto 2 months : twice a week

3rd month : once a week

4months to 1 yr : twice a month

More than 1 yr : atleast once in3months

Lab tests

Test for kidney function

Test for blood count

Test for liver function

Blood glucose

P iP i


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PrognosisPrognosis

y The donorkidney's

average life

time is 10 to15 years so it

needs second

transplantation

or for sometimes dialysis

again.


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yReferences Nicola Thomas ; Renal nursing ; Second edition, Page

no:337-400

Walch, Retik vaughan and Wein; Campbells

Urology; 8thedition; Page no: 345-373

Dr. Meenakshi Kamboj, Ms Shwetha Mattur, Dr.

Sandeep Gularia; L

iving with a transplant.

www.wikipedia.com


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