Abdominal Station
Renal Transplant
Renal Transplant
Important Physical Signs
Peripheral : (hands – arms – face – neck – torso)
- Fine Tremor (tacrolimus)🎬
- Glucose monitoring fingerpick marks (or continuous glucose monitor)
- Asterixis (uraemic encephalopathy)
- Arteriovenous fistula (brachio-cephalic or radio-cephalic)
- Anterior neck triangle – Central venous catheter scars and JVP
- Parathyroidectomy scar (tertiary hyperparathyroidism)
- Gum hypertrophy (ciclosporin)
- Warts or skin cancer resection scars (back, face, scalp)
- Peripheral oedema
Abdomen:
Presentation:
Diagnosis: Examination is consistent with a diagnosis of a right / left renal transplant.
Most pertinent positive findings are –> Important Physical Signs
Right soft round non-tender mass underlying the right iliac fossa scar (Rutherford-Morrison scar) consistent
with a right renal transplant.
Signs of post-transplant immunosuppression fine tremor and gingival hypertrophy.
Signs of end-stage renal failure with evidence of previous renal replacement therapy via haemodialysis
Arteriovenous fistula central venous catheter scars) or peritoneal dialysis (peritoneal dialysis scars)
Underlying cause of end-stage renal failure diabetes / polycystic kidney disease as evidenced by
glucometer / ballotable kidneys.
Important negative findings include:
No evidence of asterixis secondary to uraemia
No signs of fluid overload (overt JVP rise or peripheral oedema)
Differential Diagnosis:
Differential diagnosis marked as differential causes for end-stage renal failure leading to likely transplant:
• Diabetes
• Hypertension
• Glomerulonephritis
• Polycystic Kidney Disease
• Reflux nephropathy
• IgA Nephropathy
• Nephrotoxins exposure
• Obstructive uropathy
Clinical Judgement:
Bedside tests:
• Blood pressure
• Urine dipstick
• Fluid assessment
Blood investigations:
• FBC (anaemia 2ry to CKD)
• Urea and electrolytes (creatinine to assess kidney transplant function, K levels)
• Serum Bicarbonate and pH (acidosis in acute renal failure)
• Bone profile (calcium, phosphate to assess kidney function)
• PTH
• Vitamin D3
• HbA1c – steroid induced hyperglycaemia / investigate underlying cause
• Tacrolimus / Ciclosporin trough levels
Imaging Studies:
• Transplant Ultrasound with resistive indices
Special tests:
• Renal Biopsy to investigate for:
• Immunological rejection (warm and tender transplant, fevers)
• BK Virus (early post-transplant rejection)
• Chronic allograft nephropathy (disease recurrence, FSGS, IgA nephropathy,
immunosuppressive nephrotoxicity)
