Pre PACES Podcast #17 Renal transplant (part 1)
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Sep 12, 2021 Dr Revathi Jain, renal physician providing practical exam tips and transplant sign pointers; Dr Jim Moriarty, consultant nephrologist with deep transplant experience. They walk through peripheral, abdominal and neck inspection, recognizing AV fistulae and transplant scars. Short, actionable guidance on palpation, bruits, edema checks, and clues from immunosuppression.
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Quick Hand Check For Tremor And Skin Changes
- Check the hands briefly for tacrolimus tremor and skin cancers from immunosuppression, but don't overrun time on detailed nail signs.
- Revathi Jain highlights tremor peaks ~2 hours post-dose and that nail McKittrick lines are rare.
How To Recognise A Dialysis Fistula
- An arteriovenous fistula is a surgically created vein-to-artery connection providing high-flow dialysis access and is often obvious on the arm.
- Jim Moriarty: feel a thrill and listen for a bruit; absence of these suggests a non-functioning fistula.
Inspect Neck Mouth And Scars For Clues
- Inspect neck, mouth and posterior scars for clues: JVP for fluid status, small tunneled catheter scars, gingival hypertrophy from cyclosporine, and parathyroidectomy scars.
- Revathi Jain emphasises exposing both arms and looking lower on the chest for tunneled lines.