( A ) Infection
A bacterial infection
kidney-arabic@hotmail.com
Chest infections by common pathogens such as Streptococcus pneumoniae or
Haemophilus influenzae, caused by a virus , the virus , such as Gram-negative
Escherichia coli or Klebsiella caused extremely rare. Staphylococcal pneumonia
can make the condition quickly deteriorated , chest X- ray shows a majority of
small abscess formation, as the disease can not be controlled , can be fatal ,
though with the support of processing, such as intermittent positive pressure
ventilation is also useless . TB is relatively rare, but if a patient previously
infected with tuberculosis, because the immunosuppressive medications, can cause
relapse, should pay particular attention be given preventive treatment if
necessary. Kano is a star eosinophilic pathogenic bacteria that can cause
pneumonia limitations , often prone to cause brain abscess bacteria reported .
Sepsis is relatively rare, high fever , chills . It is often caused by gram
-positive bacteria, such as no effective treatment, the disease developed
rapidly, failure symptoms appear , often require enhanced care, ventilator and
boost the application of measures , but it is difficult to recover. Another
outbreak of infection often caused by refractory Clostridium (Clostridium
difficile) due. The bacteria multiply in the colon , causing pseudomembranous
colitis , for failure patients often have life-threatening , it seems prone to
after treatment with broad-spectrum antibiotics , has been clear from the spread
of the disease among patients but also with each other . If you live in the
original transplant patients infected patients stayed in bed , can cause
disease. Clostridium can also be disinfected bad sigmoidoscopy infection.
Vancomycin is the cure for the treatment of pseudomembranous colitis . Patients
with suspected bacterial infections such as suspected drug sensitivity test
results without , can be the first choice of the second-generation
cephalosporins ; as with aminoglycoside formulations , the choice of gentamicin,
but to monitor drug blood concentration levels to adjust doses , prevention of
renal toxicity damage.
2 fungal and protozoal infections
Oral Candida albicans infection is more common, effective Nystatin topical
application . Pulmonary histoplasmosis Aspergillus and more severe infections
caused by fungi , cryptococcal meningitis caused by these infections with 5 -
fluorocytosine (5-FC) , or amphotericin B effective , but before treatment
should first clear pathogens. Pneumocystis carinii pneumonia is more common in
protozoan infections diagnosed biopsy needs to be done , can trimethoprim
-sulfamethoxazole and methylisoxazole mixture (Co-trimoxazole) treatment.
Toxoplasma protozoosis , Ramsey giardiasis caused by infection in transplant
patients Pu reported.
3 virus infection
Due to the lack of effective anti-viral agents , so very difficult to deal
with a virus infection. Virus rejection increase may be the result of increasing
the antigenicity of transplanted organs .
( 1 ) CMV (cytomegalovirus, CMV): CMV infection is a common problem in
transplant unit , the incidence varies greatly , many transplant centers
consider allogeneic renal transplant recipients CMV infection rates over 70 %,
although the majority of cases, no symptoms , CMV can be very serious, is a
major cause of death. In CMV -negative by kidney donors , or if kidney donors
are CMV negative blood transfusion before , its incidence can be reduced. Often
a month of onset , clinical features are fever and lung infection symptoms ,
leukopenia after transplantation , decreased platelets , increased by a serum
diagnostic test CMV titer , or isolate the virus and determined . CMV spread to
the bladder as urine culture by the virus , can be found in the biopsy specimens
of the virus , this infection is self- limiting, the need for adequate public
support treatment, most patients can resume . However, increasing the chance of
opportunistic infections in patients with a reduced white blood cells , may be
secondary to bacterial , fungal infection. In severe cases, immunosuppressive
therapy to disable or abandon the transplanted organ , so that patients have the
opportunity to recover. Other lung infection caused by viruses , including
influenza , parainfluenza virus and other respiratory sensitive .
( 2 ) skin herpes and papilloma virus infection : pathogenic people often
great pain , herpes lesions also spread to a large area of skin and nerve
involvement , early application of iodine glycosides (Idoxuridine) is valid.
Warts caused by HPV can be spread to the anus and genitalia , treatment is more
difficult , and easy to relapse .
( 3 ) caused by the varicella-zoster Varicella : transplant patients can
cause serious problems , extensive skin lesions can lead to meningitis or
encephalitis , localized lesions of the blister with iodine glycosides effective
, systemic reactions , if any , can be applied adenosine (Adenosine
arabinosid).
In the early 1970s, due to the prevalence of viral hepatitis caused by the
death of some of hemodialysis and transplant unit staff or patients, staff
outbreaks of infection in the liver due to the formation of the antigen -
antibody complex, resulting in progressive liver failure. To patients and staff
of the routine examination of hepatitis B surface antigen (HBsAg), kidney and
blood products and people were screened for hepatitis B to reduce the occurrence
of great help . HBsAg positive patients should be given specialized machines
hemodialysis , peritoneal dialysis , or switch to CAPD law . HBsAg positive
patients for transplantation should be performed after systemic stable condition
. Preoperative take certain measures to protect patients and surgery.
(B ) a lot of cardiovascular disease in patients with advanced renal failure
have extensive atherosclerosis , while in case of hyperparathyroidism, may be
associated with vascular calcification , surgery is more complicated. Smoking is
detrimental disease , transplant patients should stop smoking.
1 hypertension in hypertensive patients with myocardial infarction risk of
accidents and cerebral blood vessels, care should be strengthened after
transplantation .
Kidney damage, especially renal ischemic changes , the activation of the
renin - angiotensin system , so in many patients with chronic renal failure have
a tendency to high blood pressure , and so far , although many effective drugs
to control high blood pressure , but there are still some patients underwent
bilateral nephrectomy need to be satisfied with blood pressure control . Kidney
transplant has little effect on blood pressure , pre- transplant patients with
normal blood pressure , hypertension may occur after surgery , which is due to
the application of cortisol caused by immunosuppressive drugs . The sudden rise
in blood pressure after transplantation may also be a sign of rejection , but
need to be combined with other clinical manifestations of judgment . When high
blood pressure can cause severe chronic renal allograft rejection or become
small kidney fibrosis , this time should also consider whether the possibility
of renal artery stenosis .
Postoperative hypertension can give to diuretics and β -blockers . If
first-line drugs can not control blood pressure, should be added with
vasodilator drugs such as hydralazine or prazosin (Prazosin). In seriously ill
patients have to use angiotensin-converting enzyme inhibitors - sulfur
methylmalonic proline (Captopril).
2 ischemic heart disease severe ischemic heart disease is a contraindication
for transplantation , such as a recent heart attack patients should be
appropriately delayed surgery. Myocardial infarction is one of the main causes
of death after the transplant , but low dose steroid therapy for myocardial
infarction with improvement.
3 arteriosclerotic peripheral vascular disease iliac vessels tend to cause
difficulties on the surgical procedure , it is best for patients over the age of
50 in the preoperative angiogram . Side renal artery and external iliac artery
anastomosis can cause external iliac artery stenosis , caused limb blood
disorder, at the time of agreement , the external iliac artery only for simple
cut , even Cprrel patch application method is also not the removal of part of
the arterial wall . Pulse in the lower extremity transplant surgery should
always check . Transplanted limb ischemia symptoms often indicate an impending
blockage iliac vessels will lead to renal infarction. In this case , you should
make an emergency angiography.
(C ) gastrointestinal complications
1 duodenal ulcer steroid immunosuppressive drugs often cause gastrointestinal
ulcers applications . So two weeks after transplant patients should consider the
application of antacid medications or applications H2 blockers . There is a
history of duodenal ulcers and internal examination positive, while waiting for
kidney transplants before , you should do first vagotomy and pyloroplasty , or
highly selective line vagotomy . Ulcers occur when the patient after
transplantation , clinical symptoms rarely , but can occur suddenly bleeding ,
black stools , or perforation. Postoperative patients complained of dyspepsia ,
endoscopy should be performed , if esophagitis, when gastric erosions, shallow
ulcers and other manifestations, should give cimetidine or ranitidine
(Ranitidine) and other drug treatment.
2 diverticulosis diverticulosis recipients are over 50 can become a serious
problem. Acute diverticulitis can cause perforation or peritonitis. In the case
of application of immunosuppressive drugs significantly increased its incidence
. Peritonitis after surgery should be actively treated colon involvement loop to
external fistula or be removed. Transverse colostomy simultaneously left iliac
fossa drainage is an effective measure. To deal with this situation in a timely
manner to avoid causing consequences.
(D ) endocrine abnormalities
1 hyperparathyroidism parathyroid hyperplasia produce too much parathyroid
hormone, are common in patients with chronic renal failure in . After a
successful transplant , tend to return to normal parathyroid function . But in
some patients the need to continue dialysis hyperparathyroidism may still have
symptoms. Also hyperparathyroidism lead to vascular calcification, which not
only cause difficulties on the surgical procedure , but also affect the
postoperative patency . If there are postoperative clinical hyperparathyroidism
, could take Iα- hydroxy cholecalciferol ( vitamin D3). If the line is invalid
parathyroidectomy .
2 diabetes treated with steroids to make abnormal glucose tolerance ,
although not overt diabetes patients urine and blood sugar, but the performance
as a latent diabetes . Therefore, all patients should be checked urine and, if
abnormal, showing mild compared . Control diet or oral hypoglycemic drugs can be
controlled. Diabetes leads to severe renal failure kidney transplant feasible ,
but the patients after treatment is more complex, the unit should have
experience in handling .
3 pancreatitis and recurrent pancreatitis related to hormone therapy ,
fortunately low incidence . When this happens when the hormone to cyclosporin A,
and be symptomatic treatment.
( Five ) malignant lesions
Is now recognized as the immune system plays an important role in terms of
prevention of tumorigenesis . But its detailed defense mechanism is not clear ,
it may be the early discovery of abnormal cells in the body , and in its
proliferation and carcinogenesis before its destruction. When the immune system
is suppressed , the occurrence of certain types of cancer the opportunity to
increase , the incidence of lymphoma in allogeneic transplant patients than the
control population of the same age incidence 100 times , more successful after
more transplant rejection fewer responders , the occurrence of tumors the more
common opportunities , may be caused by excessive immunosuppression . Various
tumors can occur , but the skin cancer, the most common lymphoid tumors , cancer
accounts for approximately 1/ 3 . In Australia , New Zealand, skin cancer is a
particular problem , the high incidence of post-transplant , mainly basal cell
carcinoma, squamous cell carcinoma, and melanoma , which have a strong tendency
to metastasis and local recurrence is easy . Treatment should be considered
based on the patient's condition , such as lesions confined , may continue to
use immunosuppressive drugs, such as the transfer has been stopped
immunosuppressive therapy should be considered .
Complications ( six ) application cortisol preparations
Cortisol immunosuppressive drugs after transplantation led to a series of
complications in play an important role in the use of small doses of cortisol or
every other day dosing can reduce the incidence of complications.
( Seven ) avascular necrosis of bone
In the early stages of kidney transplantation , because the long-term ,
high-dose application of cortisol immunosuppressive drugs , there are many long
bone destruction . Wherein the femoral head is the most common lesions , showed
ischemic necrosis of the femoral head , the patient difficulty walking, pain.
Often need to be hip arthroplasty , femoral implant exchange to restore the
patient's walking function . Knee and shoulder offenders are usually involved,
but these artificial joint implant exchange ineffective . Cortisol preparations
can cause osteoporosis, vertebral compression fractures.
( Eight ) cataract
According to statistics, about transplant patients generally 1/4 subcapsular
cataracts occur , but not many serious visual impairment occurs . Minority who
are causing serious consequences retinitis occurs, it can lead to blindness
.
(Ix ) changes in the skin
Cushing faces class can appear , accompanied by acne, thinning of the skin
loses its elasticity, the skin subjected to the creation of difficult to heal .
In particular, the anterior tibial skin , post-traumatic necrosis and chronic
ulcers can form a so-called transplant legs. This will not only extend the date
of hospitalization , and severe cases require skin grafting treatment.
( Ten ) cortisol mental symptoms
Psychiatric symptoms after transplantation may have disorientation,
hallucinations, paranoid delusions, but these symptoms may also , anesthesia ,
surgery, or patients with excessive stress and environmental factors are caused
by metabolic factors . When the hormone reduced to a maintenance dose , the
patient into a normal environment , psychiatric symptoms may subside .
没有评论:
发表评论