Pre PACES Podcast #18 Renal transplant (part 2)
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Sep 26, 2021 Dr Revathi Jain, a renal physician finishing transplant training, and Dr Jim Moriarty, a consultant nephrologist with transplant expertise, guide listeners through investigation and management of renal transplant patients. They cover bloods and imaging, tacrolimus levels and biopsies, long-term CKD care, rejection, infections, recurrent disease, immunosuppression side effects, dialysis options and vascular access.
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Kidney Biopsy Is Key For Acute Graft Dysfunction
- Consider early renal biopsy for unexplained acute graft dysfunction after excluding obvious causes.
- Biopsy differentiates acute rejection, BK virus nephropathy, drug toxicity and chronic allograft changes guiding treatment such as increasing immunosuppression.
Make Cardiovascular Risk The Priority
- Do prioritise cardiovascular risk reduction in CKD and transplant patients as the single most important long-term management goal.
- Optimise BP targets, smoking cessation, lipid therapy, manage proteinuria with ACE/ARB and use SGLT2 inhibitors where appropriate.
The Renal Clinic Focused Triple Agenda
- Address the renal triad: cardiovascular disease, anemia, and bone/mineral disorder in CKD management.
- Use IV iron/erythropoietin for renal anemia, oral sodium bicarbonate for acidosis and phosphate binders/activated vitamin D for mineral bone disease.