Renal Transplant

History:
 Cause of Graft Dysfunction and Course of Management:
 Pre Renal: Vomiting, Diarrhea, Polyuria, Increased thirst, Postural Dizziness
 Renal: Fever, Graft site pain, Increased BP, Urinary Complaints, Doppler USG finding
 Post Renal:Urinary complaints and USG Report
 Current drug doses, any manipulation in doses, recent drug Levels
 Patient Compliance
 Need for Dialysis, CMV Test, Renal Biopsy, Antibiotics, Treatment of Rejection
 Uremic Symptoms and Rest of Systemic Inquiry
 Before Operation:
 When and Where performed
 Donor Relation, Age, Sex, Blood group, Match
 Pretransplant blood transfusion/When
 Pretransplant Vaccination (HBV, Pneumococcal, Influenza)
 Induction (costlier injection, ATG, Basiliximab)
 During Operation:
 Stent Placement
 Post-Operative:
 Hypotension/Hypertension, Blood Transfusion
 Immediate or Delayed Post transplant UOP
 Post-operative surgical complications like Graft site pain, Swelling, Discharge from
wound, Need of Reexploration/Intervention
 Need for Dialysis,Renal Biopsy, Treatment of Rejection
 Post op duration of normalization of S/Creatinine, Removal of Drain, Urethral Catheter
 S/Creatinine at time of discharge, and Current Value
 Discharged after how many days, Medicine at Discharge
 Need for Subsequent Admission, Reason, Management
 Pre and Post TransplantComplications:
 DM, HTN,IHD,CVA, Gout, Malignancy,Hepatitis B and C, TB
 Treatment Complications:
 Steroids: Proximal muscle weakness e.g. on combing hair, climbing stairs, Wt. Gain,
Epigastric pain, Acne, AVN of Hip joints
 CNI: Tremors, Hypertrichosis, Gum hypertrophy
 MMF: Abd pain, Nausea, Vomiting, Diarrhea
 Etiology of ESRD:
 Stone disease, Cystic disease, D.N, Shrunken kidneys, Hematuria, frothy urine,
Rheumatological History, Causative drugs etc.
 Dialysis History:
 Duration, Frequency, Access, Problems during Hemodialysis, UOP before transplant
 In Family History, evaluate for 2nd donor if required
 Personal History
Examination:
 Oral Thrush
 Gum Hypertrophy
 Hypetrichosis
 Cushingoid Features
 Tremors
 Proximal Muscle Weakness
 Striae
 Graft Scar, tenderness, Consistency, Surface, Bruit
 Femoral Bruit