NBME -transplantation

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NBME -transplantation

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DrAlex_76
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Topics: 120
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09/23/08 - 01:43 PM

Normal 0 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} One month after undergoing an uneventful renal transplant for chronic renal failure secondary to glomerulonephritis, a 38-year-old woman is hospitalized because of increased serum urea nitrogen (BUN) and creatinine levels. Prior to transplantation, she had been receiving hemodialysis for 3 years. Current medications include cyclosporine and prednisone. Examination shows no abnormalities. Over the past 48 hours, urine output has remained stable. Both renal biopsy and a radionuclide scan confirm the diagnosis of acute rejection. Which of the following is the most effective treatment?

A
) Immediate discontinuation of cyclosporine

B
) Increased dosage of corticosteroids

C
) Diuresis and alkalinization of the urine

D
) Renal dialysis for 1–2 weeks

E
) Transplant nephrectomy Better increase dose of steroids or ....cyclosporine ?

vanshita
Forum Guru
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09/23/08 - 02:48 PM

Eagle_303
Forum Guru

Topics: 77
Posts: 655

09/23/08 - 03:07 PM

Acute rejection

First Choice ---- Steroids

Second choice = OKT3

Best of luck

nightflight1945
banned

Topics: 32
Posts: 920

09/23/08 - 03:56 PM

B
) Increased dosage of corticosteroids

DrAlex_76
Forum Guru

Topics: 120
Posts: 410

09/23/08 - 04:00 PM

i know cyclosporin is renal toxic ! so ....still dilemma b/w A and B !?

jehanzebali
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Topics: 5
Posts: 88

09/23/08 - 04:03 PM

Because in the question he has himself mentioned acute graft rejection answer will be
STEROIDS.
Yes Cyclosporin in nephrotoxic but the examiner isnt interested in that s/e at the moment. smiling face

Eagle_303
Forum Guru

Topics: 77
Posts: 655

09/23/08 - 04:04 PM

DrAlex_76 wrote:
i know cyclosporin is renal toxic ! so ....still dilemma b/w A and B !?

This dilemma is only resolved by Bx .No lab test can determine it .It is important because

If it is cyclosporine toxicity ------- stop cyclosporine
If is Acute rejection -------> continnue cyclosporine ( may be you may need to increase the dose )

nightflight1945
banned

Topics: 32
Posts: 920

09/23/08 - 04:04 PM

Yes , but the Q clearly says that it is acute rejection ,

If the same scenario was given but it didn't say about acute rejection then the cause could be cyclosporine toxicity and discontinuation were considered.

dr.d.r.agicha
Forum Newbie

Topics: 0
Posts: 26

09/27/08 - 06:15 AM

what is OKT3?

mikky
Forum Elite
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Topics: 17
Posts: 540

09/27/08 - 09:04 AM

#10

okt3 is an immunosupressent...also clled muromonab....used in cases of severe acute rejection....usually not preferred cos it causes cytokine release syndrome......the body acts as if it has severe infection and releases large amounts of cytokines causing hypotension n pyrexia...they can b minimised by prot treatment with steroids....hope this helps...

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