UMEM Educational Pearls - By Caleb Chan

The Kidney Transplant Patient in Your ED

  • Acute bacterial graft pyelonephritis is the most frequent type of sepis (bacterial pneumonia is the second most common source)
  • Obtain renal transplant imaging to evaluate for sources of infection (i.e. urinary tract obstruction, renal abscess, or urine leakage)
  • BK polyomavirus may reactivate and lead to nephritis, ureteral stenosis, or hemorrhagic cystitis
  • Pneumocystis pneumonia is the most common fungal infection in patients without prophylaxis and after prophylaxis discontinuation (adjunctive steroids for treatment is controversial)
  • Vascular access may be challenging. Avoid subclavian lines or femoral venous acess on the side of the graft
  • Cardiovascular disease is the leading cause of mortality (accounts for 40-50% of deaths after the first year following renal transplant)

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