Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ 5 stages of renal failure Most common causes of ESRD: DM, glomerulonephritis, polycystic kidney disease, and systemic HTNRenal blood flow: 3–5 mL/min/gm in normal tissueIf RBF <0.5 mL/min/gm, renal cells become ischemic and drug elimination is slowedSurvival rate of patients after renal transplantation depends on the source of the donor kidneyKidneys from a living donor seem to do better at 1 and 5 years post-transplantation compared to kidneys from a cadaverCommon causes of morbidity and mortality in renal transplant recipients include hypertension (75%), coronary artery disease (15–30%), sepsis (27%), diabetes (16–19%), neoplasm (13%), and stroke (8%)During the first year post-transplantation, most deaths are due to infectious causes ++Table Graphic Jump Location|Download (.pdf)|PrintStageDescriptionGFR (mL/min/1.73 m2)1Kidney damage with normal or increased GFR≥902Kidney damage with mild decrease in GFR60–893Moderate decrease in GFR30–594Severe decrease in GFR15–295Kidney failure<15 (or HD) ++ Living related donor (LRD):Need good bilateral renal function without h/o of diabetes, neoplasia, nor severe HTNSimilar HLA and ABO blood group antigens to kidney recipientStart maintenance IV fluids (IVF) evening before surgery and double the rate 3–5 hours before surgery for adequate hydrationRecipient:Blood pressure control – most ESRD patients have HTN – if they present hypotensive, suspect profound extracellular volume depletion. Ideally, after HD, patients should be 2–4 kg above their dry weightAntihypertensive meds: alpha blockers, such as clonidine and prazosin, can prove very useful, as well as nitroprusside and IV labetalol for acute HTNElectrolyte disturbances: hyperkalemia, hypermagnesium, etcGI disturbances: delayed gastric emptying, gastroparesis, N/V, GI bleeding, hiccupsHematologic disturbances: anemia, platelet dysfunction, and thrombocytopeniaCardiac disturbances: LVH, CHF, LV dysfunction, CAD, cardiac conduction abnormalities, and pericarditis associated with uremiaUremic pericarditis responds to dialysis and rarely leads to tamponade. Dialysis pericarditis is associated with pain, fever, and leukocytosis, and tamponade is more likelyAssess airwayDifficult intubation more common in long term type 2 DM due to diabetic stiff joint syndrome, which is characterized by a short stature, joint rigidity, and tight waxy skin. This can be seen clinically by asking the patient to approximate their palms – if they cannot bend their fingers backwards (“prayer sign”) then they may be at risk for difficult intubationBe aware of immunosuppressive treatment; some immunosuppressive drugs interact with anesthesia drugs (e.g., cyclosporine)Calcium channel blockers and certain antibiotics (e.g., erythromycin, doxycline, ketoconazole) increase levels of cyclosporine and can lead to nephrotoxicity. Other drugs, including certain antibiotics (nafcillin, isoniazid) and anticonvulsants (e.g., phenytoin, phenobarbital), decrease levels of cyclosporine and predispose the patient to infection ++ In addition to standard ASA monitors, invasive monitors are patient dependant+/− CVP monitoring for guiding rate and volume of IVF intraoperative; prefer IJ, avoid side of AVFA-line, if needed, best inserted in femoral positionArm with AVF protected; no IV, no BP ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.