eMedicine Specialties > Pediatrics: Surgery > Transplantation

Kidney Transplantation: Workup

Author: David Hatch, MD, Chief, Section of Pediatric Urology, Professor of Urology & Pediatrics, Departments of Urology and Pediatrics, Foster G McGaw Hospital and Loyola University of Chicago
Coauthor(s): Rekha Agrawal, MD, Director, Division of Pediatric Nephrology, Professor, Department of Pediatrics, Loyola University Medical Center
Contributor Information and Disclosures

Updated: Mar 24, 2009

Workup

Laboratory Studies

The following studies are indicated in kidney transplantation:

  • CBC count
  • Complete metabolic panel
  • Coagulation studies: These should include prothrombin time, activated partial thromboplastin time, and international normalized ratio (INR).
  • Panel reactive antibody (PRA): Recipient serum is incubated with WBCs pooled from a group of blood donors with human leukocyte antigen (HLA) types representative of the community. Cell kill indicates that the recipient has antibodies against the donor cells. PRA, the percentage of the donors against which the recipient reacts, is used as a predictor of the likelihood of a positive cross-match that would prevent transplantation.
  • Viral titers (ie, cytomegalovirus [CMV], herpes simplex virus [HSV], varicella-zoster virus [VZV], Epstein-Barr virus [EBV], hepatitis B virus [HBV], hepatitis C virus [HCV], HIV)
    • Children who demonstrate no antibody to CMV, VZV, and EBV are at increased risk of posttransplant primary infection, especially if they receive kidneys from donors who are seropositive for these viruses.
    • Closely monitor such recipients following transplantation and provide appropriate antiviral therapy (agents that prevent viral proliferation or antibodies directed against a specific virus).
    • Ensure that all children are immunized against HBV prior to transplantation.

Imaging Studies

  • Imaging studies include chest radiography and abdominal ultrasonography.
  • The medical history should provide a thorough evaluation of the child's urologic pattern. A history of congenital urologic anomaly, recurrent urine infections, and/or voiding abnormalities (eg, incontinence, frequency, urgency) identifies children who should undergo further urologic imaging or evaluation, including voiding cystourethrography and possible urodynamic studies.

Other Tests

  • A urodynamic study is a functional evaluation of the bladder that measures bladder capacity, bladder storage pressures, voiding function and pressure, and coordination of the components of the lower urinary tract.
  • In children with a history of voiding dysfunction (eg, incontinence) or major reconstruction of the lower urinary tract, perform urodynamic evaluation to determine bladder capacity and compliance and also to evaluate competence of the continence mechanisms.
  • If low bladder capacity, high storage pressure, incomplete emptying, or high voiding pressure is found on urodynamic testing, instituting intervention prior to transplantation to prevent urine infection, urinary obstruction, or incontinence may be appropriate.

More on Kidney Transplantation

Overview: Kidney Transplantation
Workup: Kidney Transplantation
Treatment: Kidney Transplantation
Follow-up: Kidney Transplantation
Multimedia: Kidney Transplantation
References
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References

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Further Reading

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Keywords

kidney transplantation, transplant, kidney transplant, end-stage renal disease, ESRD, renal transplant, renal transplantation, kidney donation, dialysis, hemodialysis, glomerulonephritis, histocompatibility antigens, HLAs, kidney rejection, nephrectomy, systemic lupus erythematosus, Goodpasture syndrome, Goodpasture disease, focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, hemolytic-uremic syndrome, Henoch-Schönlein purpura, continuous ambulatory peritoneal dialysis, CAPD, treatment, kidney failure, renal failure 

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Contributor Information and Disclosures

Author

David Hatch, MD, Chief, Section of Pediatric Urology, Professor of Urology & Pediatrics, Departments of Urology and Pediatrics, Foster G McGaw Hospital and Loyola University of Chicago
David Hatch, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Society of Transplant Surgeons, and American Urological Association
Disclosure: Watson Pharma Grant/research funds Other; Mentor Corporation Grant/research funds Other

Coauthor(s)

Rekha Agrawal, MD, Director, Division of Pediatric Nephrology, Professor, Department of Pediatrics, Loyola University Medical Center
Rekha Agrawal, MD is a member of the following medical societies: American Society of Pediatric Nephrology and International Society of Nephrology
Disclosure: Nothing to disclose.

Medical Editor

Casimir F Firlit, MD, PhD, Attending Urologist, Department of Urology, Cardinal Glennon Children's Medical Center; Surgical Director, Pediatric Urology Specialists, PC, Cardinal Glennon Children's Medical Center
Casimir F Firlit, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Society of Transplant Surgeons, American Urological Association, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Brian F Gilchrist, MD, Surgeon-in-Chief of Pediatric Surgery, The Floating Hospital for Children at Tufts-New England Medical Center; Associate Professor, Department of Surgery, Tufts University School of Medicine
Brian F Gilchrist, MD is a member of the following medical societies: American College of Surgeons, American Pediatric Surgical Association, and Society for Surgery of the Alimentary Tract
Disclosure: Nothing to disclose.

CME Editor

Ron Shapiro, MD, Professor of Surgery, Robert J Corry Chair in Transplantation Surgery, Director, Kidney, Pancreas, and Islet Transplantation, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center
Ron Shapiro, MD is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, Association for Academic Surgery, Central Surgical Association, and Society of University Surgeons
Disclosure: Astellas Honoraria Speaking and teaching; Brystol Meyer Squibb StemCell Data Monitoring Committee Consulting fee Review panel membership; Wyeth Honoraria Speaking and teaching; Stem Cells, Inc Consulting fee Review panel membership; Up To Date contracted Author; Medscape contracted Video Blogger

Chief Editor

Stuart M Greenstein, MD, Professor of Surgery, Albert Einstein College of Medicine; Consulting Surgeon, Department of Surgery, Division of Transplantation, Montefiore Medical Center
Stuart M Greenstein, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, International College of Surgeons, Medical Society of New Jersey, National Kidney Foundation, New York Academy of Sciences, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

 
 
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