I. Medical history
1. Pay attention to the type of primary disease.
2.Inquire about the history of hypertension, ulcer disease, tuberculosis, hepatitis, infectious diseases (dental caries, periodontal disease, sinusitis, chronic bronchitis, bronchiectasis, urinary tract infection, etc.), psychiatric disease, malignant tumor, disorders of coagulation mechanism, systemic vascular diseases (such as polyarteritis nodosa, diffuse vasculitis), urinary tract malformations, stones, oxalic acid deposition, etc.
3.Previous treatment history, dialysis time and frequency.
4.Past blood transfusion and medication use.
5.History of menstruation and marriage and childbirth.
Physical examination
1.Comprehensive examination of heart, blood vessels, respiratory system, liver, spleen and lymph nodes of the whole body.
2. Pay attention to the presence of anemia, edema, heart enlargement, pulmonary rales, pleural fluid, ascites, and hepatomegaly.
3. Pay attention to the presence of skin and mucous membrane infections and skin diseases.
4. Pay attention to the presence of hidden foci of infection (prostate, pelvis, tonsils, and interdigital toe).
C. Laboratory tests
1, blood, urine routine, BT, CT, urine specific gravity.
2, urine, stool, nasopharyngeal secretions, sputum smear and culture.
3.Blood group, condensation set test.
4.Blood biochemistry, creatinine clearance
5.HBsAg.
6.Urine β2-microglobulin.
7.Urine γ-GT, NAG.
8.Urine cytology.
IV. Special examination
1.Chest X-ray.
2.ECG, echocardiography.
3.B ultrasound (liver, bile, pancreas, spleen, both kidneys, ureter, bladder).
4.KUB.
5.Isotope renal dynamic scan.
V. Preoperative preparation
1.General preparation.
2.Dialysis: increase dialysis once within 24 hours before surgery.
3.Allocate 400ml of fresh blood.
4.Oral azathioprine 200mg on the day before and on the day of surgery.
5.Lymphocytotoxic antibody test.
6.Inject 200ml of saline + 160,000 units of gentamicin into the bladder before surgery.
7.Preoperative prophylactic antibiotics.
8.Preoperative talk.
Intraoperative drug administration
1.Giving intravenous methylprednisolone 250mg when cutting skin, and then giving intravenous methylprednisolone 250mg and cyclophosphamide 200mg when opening circulation.
2. Give 40-100mg of tachyphylaxis and 250ml of mannitol intravenously before opening the circulation.
3.Intraoperative prophylaxis with antibiotics.
VII. Postoperative treatment
1. Pay close attention to P, BP, and R after surgery, and measure them once every hour, then once every 4 hours after stabilization. Take temperature 4 times a day.
2. Pay attention to the local signs and wound bleeding, record the wound drainage, and generally remove the drainage tube in 48-72 hours.
3. Keep the ureter and ureteral stent tube, measure the hourly urine volume and urine specific gravity, and remove them in 7-10 days, and measure each urine volume and urine specific gravity after removal.
4.Record the in and out volume, pay attention to the water and electrolyte balance
5.Prevent and control postoperative infection, routinely use broad-spectrum antibiotics with little kidney damage. Pay attention to sterilization and isolation, oral care and urethral care.
6.Encourage the patient to take deep breaths, cough, assist in turning and patting the back to prevent pulmonary complications.
7.Check blood and urine routine every day for two weeks after surgery.
8.Measure blood K, Na, Cl, CO2CP, BUN, Glu every day for two weeks after surgery.
9. Urine culture twice a week for two weeks after surgery.
10.Urinary enzymes and urine cytology will be checked three times a week within two weeks after surgery.
11.Liver function and Cr, CCr check twice a week.
12.Anti-rejection medication (see table).
13.Tachyphylaxis, hepatoprotective drugs, antiviral drugs, antifungal drugs, antacids, etc. as appropriate.
14.Cyclosporine A blood concentration should be measured once a week.