- Renovascular hypertension is most commonly caused by atherosclerotic renal artery stenosis (older patients) or fibromuscular dysplasia (younger women).
- Fibromuscular dysplasia classically affects the mid-to-distal renal artery with a "string of beads" appearance; treated with angioplasty (no stent).
- Atherosclerotic RAS typically affects the ostium/proximal renal artery and is associated with diffuse atherosclerosis.
- ACE inhibitors are contraindicated in bilateral renal artery stenosis or RAS in a solitary kidney (risk of acute kidney injury).
- Living donor kidney transplantation has better outcomes than deceased donor; HLA matching improves graft survival.
- The left kidney is preferred for living donation due to longer renal vein (easier anastomosis).
- Standard immunosuppression: induction (basiliximab or thymoglobulin) + maintenance (calcineurin inhibitor + antimetabolite + steroid).
- Calcineurin inhibitors (tacrolimus, cyclosporine) are nephrotoxic; monitor levels closely.
- Transplant recipients have increased risk of skin cancer, lymphoma (PTLD), Kaposi sarcoma, HCC; kidney, penile, and bladder cancers also increased.
- Prostate cancer incidence is actually decreased in transplant recipients.
- Hemorrhagic cystitis in immunosuppressed patients is most commonly associated with adenovirus (and BK virus).
- BK virus nephropathy is managed by reducing immunosuppression.
- Fertility is generally restored after successful transplantation; pregnancy should be delayed at least 1 year post-transplant.