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1. RENAL PRE-TRANSPLANT MEET Dr. Manoj Aryal/ Dr. Bir Bahadur Thapa DM Nephrology Resident/ MCh Urology Resident NAMS, Bir Hospital (2081-02-27)

2. DESCRIPTIONS DESCRIPTION RECIPIENT DONOR NAME Manisha Pandey Mina Devi Pandey Khatri AGE 29yrs 56yrs SEX Female Female RELATION Daughter Mother BLOOD GR/TYP B Positive O positive ADDRESS Nepalgunj-8 Banke. Kolhapur-8 Banke. Height 5 feet 5 inches 5 feet 3 inches Weight 48 kg 56 kg BMI 18kg/m2 22kg/m2

3. VIRAL MARKER DESCRIPTION RECIPIENT DONOR HIV I / II (2081/02/20) Non-Reactive Non-Reactive HBs Ag (2081/02/20) Non-Reactive Non-Reactive Anti HCV (2081/02/20) Non-Reactive Non-Reactive CMV IgG Positive Positive CMV IgM Negative Positive

4. RECIPIENT CLINICAL DETAILS HISTORY/ PRIMARY DISEASE: CKD-SLE WITH HTN WITH SEIZURE DISORDER . DIALYSIS STATUS : HD via Right IJ catheter since 6 weeks Under MHD since 6 weeks (Sunday)

5. RECIPIENT INVESTIGATION HEMATOLOGY(2081/02/20) HB 10.8 TLC 6580 DC Neutrophils 75% Lymphocytes 12% Monocytes 10% PLT 158000 PT/INR 12.1/1.00 BT 2 CT 5

6. RECIPIENT INVESTIGATION BIOCHEMISTRY RBS(2081/02/20) 93 Total Bilirubin 0.4 FBS (2081/02/08) 97 Direct Bilirubin 0.1 HBA 1 C (2024/03/19) 5.5% SGPT 6 UREA(2081/02/20) 114 SGOT 10 CREATININE 10.5 ALK.PHOS 101 NA + 137 T. PROTEIN 5.2 K + 4.2 S. ALBUMIN 3.6 CALCIUM 9.1 IPTH (2024/03/19) 589 PHOSPHORUS 8.1 ANA(2080/12/07) Positive URIC ACID 3.5

7. RECIPIENT INVESTIGATION ANA Positive TFT (2081/02/20) FT3/FT4 2.30/0.96 TSH 1.47

8. RECIPIENT INVESTIGATION (2081/02/20) URINE ANALYSIS ALBUMIN + SUGAR Nil RBC Nil WBC Nil CAST Nil URINE CULTURE (2081/02/20) No Growth

9. RECIPIENT INVESTIGATION ECG :NSR USG: B/l small echogenic kidneys with loss of CMD, Cholelithiasis. ECHO: (2080/12/13) LVEF 6O%, Mild MR. CXR –PA: (2081/02/21) NORMAL STUDY

10. Stress ECHO Revealed Baseline LVEF 60% Peak LVEF 70% .Normal wall motion analysis at rest, Peak exercise and recovery. Good Contractile reserve. Test is Negative for Reversible myocardial ischemia

11. TREATMENT CARDEX S.N MEDICATION DOSE ROUTE DIRECTIONS 1 TAB CLINIDIPINE 20 MG PO BD 2 TAB METLOC XL 50 MG PO OD 3 TAB TORSEMIDE 100MG PO BD 4 TAB LEVERA 500 MG PO BD 5 CAP PANCARE DSR 1 CAP PO BD 6 INJ EPOFIT 10000U S/C THRICE A WEEK 7 TAB CORTILONE 10MG PO OD 8 TAB MEONE 1 TAB PO OD 9 TAB FOLVITE 5 MG PO 0D 10 TAB PHENYTOIN 100MG PO TDS 11 TAB LACOSAMIDE 50MG PO BD

12. Recipient Systemic Evaluation Clearance Chest Evaluation: Done and Cleared Cardiac Evaluation: Done and Cleared ENT Evaluation : Done and Cleared Dental Evaluation : To be Cleared Urology: Done and Cleared PSYCHIATRY No active intervention required PAC : To be reviewed GYNAECOLOGY : Done and Cleared

13. DONOR EVALUATION No Known Comorbidity. 

14. DONOR INVESTIGATION HEMATOLOGY (2081/02/20) HB 13gm% TLC 6620 DC Neutrophils 60% Lymphocytes 31% Monocytes 07% Eosinophils 02% PLT 267000 PT/INR 11.6/0.95 APTT 29.0 sec BT 2 mins CT 8 mins

15. DONOR INVESTIGATION BIOCHEMISTRY(2081/02/20) RBS 135 HbA 1 C 6.1% UREA 33 Total Bilirubin 0.4 CREATININE 0.7 Direct Bilirubin 0.2 NA + 145 SGPT 17 K + 3.9 SGOT 16 CALCIUM 9.8 ALK.PHOS 78 PHOSPHORUS 2.6 T. PROTEIN 7.2 URIC ACID 4.5 S. ALBUMIN 4.7

16. DONOR INVESTIGATION ANA Neg TFT (2024/03/08) FT3/FT4 3.07/1.00 TSH 0.68

17. DONOR INVESTIGATION(2081/02/20) URINE ANALYSIS ALBUMIN Nil SUGAR Nil RBC Nil WBC Nil CAST Nil URINE CULTURE No Growth

18. DONOR INVESTIGATION ECG: NSR USG(2080/12/16) Both kidneys are normal in size Rt 8.6cm,Lt 9.8cm, outline and echotexture. CMD is maintained. ECHO(2024/03/06): LVEF:60%,NORMAL STUDY. CXR –PA: Grossly normal Spirometry: Normal

19. DONOR Systemic Evaluation Clearance Chest Evaluation: Done and Cleared Cardiac Evaluation: Done and cleared ENT Evaluation : No active intervention required Dental Evaluation : Done and Cleared UROLOGY: Done and Cleared PSYCHIATRY Done and Cleared PAC To be Reviewed CTVS Done and cleared OB/GYNE Done and cleared.

20. DSA (17/03/2024) ANTI HLA IgG antibodies MFI Result CLASS I <500 NEGATIVE CLASS II <500 NEGATIVE CDC Cross Match Auto:- IgM NEGATIVE DTT cross match:- T & B cell cross match NEGATIVE

21. HLA-Typing Report Awaited

22. Legal clearance Done

23. CT-Renal Angiography Side Vasculature Number Length(mm) Diameter(mm) Right Renal Artery Two 26 4 Renal Vein Single 25 10.7 Left Renal Artery Single 27 6.1 Renal Vein Single 50 8.9 Impression: Accessory right renal artery arising from the aorta 4cm below the origin of main RA – lower pole, rest Normal CT- Renal Angiogram findings B/L normally excreting kidney

24. Arteriography

25. Venography

26. Collecting System

27. 99M TC- DTPA Renogram Impression: Normal Functioning Right kidney with non-obstructive clearance. Normal Functioning Left kidney with non-obstructive clearance. Left Kidney Right Kidney Differential Function 52 48 GFR (mL/min/1.73 m 2 ) 44.0 41.3 Normalized GFR (mL/min) 94.6

28. PLAN Left Laparoscopic Donor Nephrectomy