Page 144 - Critical Care Notes

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GU
■ Obtain daily urinalysis, urine electrolytes, urine for acetones, and urine
culture and sensitivity.
■ Administer immunosuppressive drug therapy (↑ risk of infection). These
may include glucocorticosteroids, cyclosporine, tacrolimus.
■ Monitor daily weight.
■ Administer IV fluids cautiously.
■ Administer diuretics as needed.
■ Obtain daily basic metabolic panel (BMP). Assess electrolytes, BUN, creati-
nine, osmolarity, CBC.
Institution-Specific Care:
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Complications
■ Rejection (most common and serious complication): A reaction between the
antigens in the transplanted kidney and the antibodies in the recipient’s
blood → tissue destruction → kidney necrosis. Rejection can occur at any
time from immediately to many years later.
■ Thrombosis to the major renal artery may occur up to 2–3 days postop
→ may be indicated by sudden ↓ in urine output → emergency surgery is
required to prevent ischemia to the kidney.
■ Renal artery stenosis → HTN is the manifestation of this complication → a
bruit over the graft site or ↓ in renal function may be other indicators → may
be repaired surgically or by balloon angioplasty.
■ Vascular leakage or thrombosis → requires emergency nephrectomy surgery.
■ Wound complications: hematomas, abscesses →↑ risk of infection → exer-
tion on new kidney. Infection is major cause of death in transplant recipient.
These patients are on immunosuppressive therapy → signs and symptoms
of infection may not manifest in the usual way. Watch for low-grade fevers,
mental status changes, and vague complaints of discomfort.
Radical Nephrectomy
Radical nephrectomy is the removal of the kidney; the ipsilateral adrenal gland;
surrounding tissue; and, at times, surrounding lymph nodes. Because of the
increased risk of recurrence in the ureteral stump, ureterectomy may be per-
formed as well.

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