0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

Treatment

■ Intraperitoneal (not IV) antibiotics: Vancomycin or third-generation

cephalosporin

RENAL TRANSPLANT COMPLICATIONS

Renal transplants have survival rates of 96% at 1 year and 91% at 3 years.

Infections

Infections are most common during the first 6 months following transplant

surgery (when immunosuppressant doses are highest) and are the most common

cause of morbidity and mortality in the first posttransplant year.

ETIOLOGY

■ Overall bacterial infections are most common.

■ Immediately following surgery: Typical bacterial postoperative organisms

(Staphylococcus, Streptococcus, E. coli).

■ Months 1–6: Highest incidence of viremia and opportunistic infections,

most notablyCMVinfection, but also EBV, HSV, herpes zoster, Pneumo-

cystis carinii,Listeriameningitis, and fungal sepsis.

SYMPTOMS/EXAM

■ Varies with underlying etiology.

■ CMV: Fever spikes, malaise, arthralgias, lymphadenopathy, pneumonitis,

retinitis, hepatitis

■ Primary EBV: Mononucleosis-like syndrome

DIAGNOSIS

■ CXR, UA, CBC, chemistries, blood cultures, urine cultures, viral PCR

TREATMENT

■ Depends on suspected underlying cause

■ CMV: Gancyclovir or foscarnet

■ Primary EBV: Reduce immonosuppression, acyclovir

■ HSV or herpes zoster: Acyclovir

■ Fungal sepsis: Amphotericin

Graft Rejection

Types of rejection:

■ Hyperacute:Occurs within minutes to hours after transplant surgery and

results in graft destruction

■ Acute:Occurs within 1–12 weeks following surgery, mediated through

attack by T lymphocytes against antigen donor tissues

■ Chronic:Results from nephrosclerosis and subsequent ischemia to the graft

SYMPTOMS/EXAM

■ Low-grade fevers, malaise

■ Worsening hypertension, increased creatinine

■ Weight gain, peripheral edema

■ Tenderness to palpation over the graft

CMV is the most common life-

threatening infection in solid

organ transplant patients.

CMV infections are treated

with gancyclovir or foscarnet.