graft vein thrombosis after renal transplantation
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in adult renal transplant recipient, the graft vein was anastomosed to the recipient external iliac vein. many factors contribute thrombosis: recombanc postoperative ? ABMR & VASCULITIS SURGICAL ANASTOMOSIS
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Similar to graft vein thrombosis after renal transplantation
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Cerebral Venous Sinus Thrombosis 2010 - Dr. Rajiv Jha (Neurosurgeon Nepal)
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Dr Rajiv Jha, MS
Senior Resident M Ch Neurosurgery
National Neurosurgical Referral Center
National Academy Of Medical Sciences
Changes in blood coagulation markers associated with uterine artery embolizat...
Changes in Blood Coagulation Markers Associated with Uterine Artery Embolization for Leiomyomata
Dr. Hilario Martinez of http://www.palmvascular.com
Urban P
The document discusses bleeding as a complication of percutaneous coronary intervention (PCI) and antiplatelet therapy, noting that bleeding is associated with significantly increased mortality and morbidity, and that assessing bleeding risk, optimizing vascular access through the radial approach, and tailoring antiplatelet treatment can help address this problem. Major causes of bleeding include access site complications and prolonged dual antiplatelet therapy beyond 6 months without clear benefits.
San jose 2011
This document discusses endovascular treatment for acute ischemic stroke. It describes the goals of endovascular treatment as expanding the treatment window, including patients resistant to IV treatment or who have exclusion criteria, and increasing recanalization rates. Various endovascular treatments are discussed such as thrombolytic drugs, mechanical thrombectomy devices, and angioplasty. Complications of treatment like hemorrhagic transformation are also reviewed. Clinical trials demonstrating the safety and efficacy of endovascular therapies like the MERCI Retriever and Solitaire device are summarized.
Acute Renal Failure Lecture
The document discusses the history and development of acute renal failure treatment from the first dialysis machines in the 1920s to modern biomarkers and therapies. It covers key events and discoveries like Dr. Kolff's first patient surviving hemodialysis in 1943. Classification systems for acute renal failure like RIFLE are presented along with the limitations of creatinine as a marker. Biomarkers like KIM-1 and NGAL are proposed as more accurate indicators of kidney injury. Differential diagnosis and treatment options such as renal replacement therapy are also summarized.
Dissolution trial
Thrombus aspiration during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is said to reduce PCI-induced distal occlusion.
In an attempt to enhance its effectiveness, thrombus aspiration is often coupled with glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors, although conflicting results with this strategy have been reported.
GP IIb/IIIa antagonists inhibit the final common pathway that leads to platelet aggregation and leukocyte plugging, which are the main components of fresh thrombi.
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A 73-year-old man presented with a 3-year history of progressive memory loss, poor balance, and recent urinary incontinence. Examination showed impaired memory and difficulties with calculations and gait. Brain imaging showed enlarged ventricles and white matter changes. Laboratory tests did not reveal a treatable cause of dementia. The patient's gait improved transiently after lumbar puncture. This document discusses normal pressure hydrocephalus (NPH) and reviews tests to diagnose NPH such as CSF pressure measurement, CSF removal tests, and CSF resistance measurement. It also discusses predictors of shunt response and treatment options for NPH.
Early recurrence and cerebral bleeding in patients with acute ischemic stroke...
(1) This study evaluated the risk of recurrent stroke and bleeding in patients with acute ischemic stroke and atrial fibrillation treated with different types and timings of anticoagulation.
(2) It found that initiating anticoagulation between 4-14 days had the lowest risks, with a 7.6% risk of recurrent stroke and 3.6% risk of symptomatic bleeding.
(3) Oral anticoagulants alone were associated with the lowest bleeding risk, while low molecular weight heparin followed by oral anticoagulants or low molecular weight heparin alone had higher bleeding risks.
AKI Lecture 2010
The document discusses the history and development of dialysis for treating acute renal failure. It describes how Dr. Haas invented the first dialysis machine for humans in 1928 but all 6 of his initial patients died. Dr. Kolff then created the second human dialysis machine in 1943 and was able to successfully treat his first patient. The document also examines biomarkers like KIM-1 and NGAL that can help diagnose acute kidney injury earlier than creatinine. It analyzes the RIFLE criteria for classifying the severity of acute renal failure.
Pulmonary Thromboembolism | Jindal Chest Clinic
Pulmonary Thromboembolism is a blood clot that originates in a deep vein in the leg and travels to the lung, blocking blood flow to an artery in the lung. A clot in a different vein is an uncommon condition known as deep vein thrombosis (DVT). For more information, please contact us: 9779030507.
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Cerebral Venous Sinus Thrombosis 2010 - Dr. Rajiv Jha (Neurosurgeon Nepal)
Cerebral Venous Sinus Thrombosis 2010 - Dr. Rajiv Jha (Neurosurgeon Nepal)
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Changes in blood coagulation markers associated with uterine artery embolizat...
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Plasmapheresis is a medical procedure that separates blood components to remove plasma. There are three main types: autologous, therapeutic exchange, and donation. Autologous plasmapheresis removes a patient's own plasma, treats it, and returns it to remove antibodies, immune complexes, or toxins. It is used to treat various neurological, hematological, metabolic, dermatological, and renal diseases. Complications can include hypotension, allergic reactions, hemorrhage, hypocalcemia, and infections from replacement fluids. Plasmapheresis removes drugs and proteins from plasma like IVIG and monoclonal antibodies but not drugs like steroids that are widely distributed in tissues. It is used pre- and
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organ transplantation also need
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This document provides recommendations for fasting during Ramadan for those with diabetes. It categorizes risk levels as very high, high, moderate, and low based on factors like blood sugar control and medical history. For each risk level, it recommends whether fasting is advised against or can be done with/without caution. It also reviews common diabetes medications and provides guidance on any dosage adjustments or precautions needed when taking them during Ramadan fasting. Finally, it outlines the religious opinion of the Egyptian Fatwa Authority, which is that fasting should avoid hardship and harm for all patients with diabetes.
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immunosuppressive drugs after renal transplantation need more adjustment, need immunometery test that help in assessment of immunity state
Irm
This document discusses various topics related to immunosuppressive drugs used in renal transplantation. It begins by reviewing mTOR inhibitors used in combination with calcineurin inhibitors, noting their synergistic effect. It then discusses a study finding lower rates of discontinuation and better graft function with mTORi-CNI compared to MMF/MPA-CNI. Finally, it briefly touches on induction immunosuppression methods, tolerance without immunosuppression, and withdrawal of steroids and calcineurin inhibitors.
immunosuppressive drugs
This document discusses immunosuppressive therapy for renal transplantation. It covers various types of immunosuppressive drugs used for induction and maintenance, including calcineurin inhibitors (CNIs), mTOR inhibitors, steroids, and antiproliferatives. It provides information on monitoring drug levels, drug toxicities, and strategies to improve graft survival like avoiding high intrapatient drug level variability. It also addresses the impact of immunosuppressive drugs on male reproduction and pregnancy.
Diabetes
This document discusses post-transplant diabetes mellitus (PTDM), covering its definition, risk factors, diagnostic criteria, management, and the effects of various immunosuppressive and antidiabetic drugs. It provides questions and answers on topics like the most common cause of end-stage kidney disease in the US, risk factors for PTDM, criteria for diagnosing diabetes and prediabetes, preferred tests for diagnosing diabetes after transplantation, and factors that affect immunosuppressant and antidiabetic drug levels.
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Membranoproliferative glomerulonephritis (MPGN) is characterized by three histopathologic findings: proliferation of mesangial and endothelial cells, thickening of peripheral capillary walls, and mesangial interposition into capillary walls. It can present with asymptomatic proteinuria and hematuria, nephrotic syndrome, acute nephritic syndrome, or recurrent gross hematuria. Treatment involves immunosuppression, antiplatelet agents, anticoagulants, and anti-inflammatory drugs. Recurrent disease is common after kidney transplantation.
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Membranoproliferative Glomerulonephritis (MPGN) is a type of glomerular disease characterized by three histological findings: proliferation of mesangial and endothelial cells, thickening of capillary walls, and mesangial interposition into capillary walls. It accounts for 6-12% of renal biopsies performed to evaluate glomerular disease. Presentations include asymptomatic proteinuria and hematuria, nephrotic syndrome, acute nephritic syndrome, and recurrent gross hematuria. Recurrence is common after kidney transplantation.
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This document discusses the role of continuous renal replacement therapy (CRRT) in liver transplantation. It provides details on how to prescribe CRRT, including blood flow, dose, mode, substitution fluid, dialysate flow, fluid removal, fluid addition, and anticoagulation. It compares CRRT to intermittent hemodialysis. It then presents a case scenario of a patient undergoing liver transplantation who develops hepatorenal syndrome and requires CRRT intraoperatively and postoperatively based on their condition of massive blood loss, hypotension, and anuria. The CRRT prescription and monitoring of the patient over one week is described, showing recovering kidney function.
Crrt livertx
This document discusses the role of continuous renal replacement therapy (CRRT) in liver transplantation. It provides details on how to prescribe CRRT, including blood and dialysate flow rates, substitution fluid used, and anticoagulation. It notes CRRT is useful for hemodynamically unstable patients undergoing liver transplant due to complications like blood loss and hypotension. The case scenario describes using CRRT intraoperatively and postoperatively for a patient with liver and kidney failure undergoing liver transplant who experienced blood loss and hypotension.
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This document discusses sexual and reproductive health issues after kidney transplantation. It notes that more than half of male patients with renal failure have biochemical hypogonadism, which is a risk factor for sexual dysfunction. Several medications commonly used after transplantation can negatively impact erectile function and fertility in men. Treatment with phosphodiesterase 5 inhibitors can help erectile dysfunction. Female patients may experience ovulatory and menstrual irregularities due to hypothalamic-pituitary changes from chronic kidney disease. Pregnancy is possible after transplantation if kidney function is good with no proteinuria or hypertension and at least one year post-transplant. Fertility preservation techniques before transplantation like ovum pickup and preservation are discussed.
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During a 6-year period, 499 patients with morbid obesity and either end-stage renal disease or chronic kidney disease were evaluated for possible sleeve gastrectomy surgery. A total of 243 patients, 198 with end-stage renal disease and 45 with chronic kidney disease, underwent sleeve gastrectomy from December 2011 through February 2018. Immunosuppressive drugs, graft biopsy, and median follow-up period of 5.8 years were examined.
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5. ECG in Medical Practice by ABM Abdullah, 4th edition
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graft vein thrombosis after renal transplantation
- 1. 200707683 Case No. 1 A 34 year old male patient. C.R.F. was maintained on C.H.D. The donor was his brother , Same blood group. HLA & DR mismatch PRA : class I= 4% (DNS) class II= zero% Renal transplant 19th Jan., 2008 50%
- 2. Operative details Artery internal iliac artery Vein external iliac vein Ischemia time : 45 minutes Immediate duiresis &
- 3. Smooth immediate postoperative course Maintained on steroid , CSA, AZA S.Cr. On discharge : 1.1mg/dl
- 4. One month Post transplantation • oliguria • ↑ S.cr.1.1 →3.2 mg/dl Clinical picture: Differential diagnosis: ?rejection ?Obstruction ?Vascular occlusion
- 5. Graft Doppler & U.S. Patchy perfusion Absent diastolic flow Basal On day of event
- 6. BiopsyBiopsy Picture of Acute Humoral Rejection Focal +ve C4d StainingATN like picture
- 7. Marked right Lower limb oedema. Doppler US Sluggish flow in the deep venous system Next Day:
- 8. MRA Thrombosed graft vein. Thrombosed RT external iliac vein. Patent IVC Patent graft artery Thrombosed RT common femoral vein.
- 9. OPTIONS FOR TREATMENT: Local injection of streptokinase Exploration & thrombectomy Graft nephrectomy GRAFT VEIN THROMBOSIS Systemic injection of streptokinase Combined local & systemic injection of streptokinase
- 16. Follow up MRA
- 17. Angiography was done Local injection of streptokinase 750 000 IU Systemic injection of Streptokinase 100 000IU/hr LMWH Plus oral anti-coagulant LMWH stopped when target INR 2-3 achieved GRAFT VEIN THROMBOSIS
- 18. CurrentlyCurrently Recovered graft functionRecovered graft function:: S. cr = 0.8 mg/dlS. cr = 0.8 mg/dl UU.O.P = 5 L/day.O.P = 5 L/day Patient under treatment of CMV disease
- 20. Graft vein thrombosis RVT has incidence of 0.55:3.4% One third of early allograft losses. One case reported just compression of the vein due to abnormal position of the graft (Nephron 1996;73:480-481)
- 21. diagnosis time management reference Renal vein compression 3rd day Exploration& nephropexy Nephron 1996 Partial thrombosis of graft vein 11months Selective intra- arterial administration of streptokinase Nephrol Dial Transplant 1998 Renal vein thrombosis 8th day Exploration& thrombectomy Nephrol Dial Transplant 2006
- 22. •Number of transplanted cases : 1969 •2003: one case suffered from both graft artery & vein thrombosis managed by nephrectomy •2008 One case of graft vein thrombosis managed by local & systemic injection of streptokinase
- 23. Conclusion: Close follow up Early detection & diagnosis Perfect intervention & cooperation Recent advances in treatment of vascular rejection =Good outcome