Renal transplant recipient and presentation

Management of renal transplant

1. MRS. DEEPIKA SINGH LIVE RELATED RENAL ALLOGRAFT RECIPIENT

2. 41 -year-old lady from Dehradun Married, Home-maker Hypertensive since 6 months ESRD on thrice weekly maintenance dialysis since 6 months, access—left AV fistula NKD – ? CGN Blood Group – A positive Residual urine – nil Donor – Elder Brother ( O positive) DSA Luminex – anti HLA CLASS I & II <1000 Negative, Vaccinations- vaccinated against covid 19

3. HISTORY: History dates back 6 months back when she developed reduced appetite, generalized weakness, nausea and vomiting. Upon evaluation for the same on routine evaluations she was found to have severe azotemia, serum creatinine of 9 mg/dl. She was initiated on hemodialysis via a jugular hemodialysis sheath in view of uremic symptoms and severe azotemia. No h/ o pedal oedema, hematuria, oliguria, shortness of breath Family history of CKD, calculus kidney disease or h/o nsaids or alternative medications. Ultrasound abdomen showed a solitary kidney and grade IV parenchymal changes.

4. She was advised to continue maintenance hemodialysis thrice weekly and was prescribed with BP medications. OBGY history: 2 full term caesarean deliveries in 2007 and 2012 respectively. No h/o PIH or other significant gestational history. She has regular cycles 3/30,

5. No H/O Ethanol consumption, smoking No H/O Asthma , COPD, Bronchiectasis, allergies No H/O TIA, Stroke No H/O Jaundice, pancreatitis, cholecystitis, gastritis, Malena No H/O Fractures, Implants , dental caries No H/O NSAIDS No H/O Malignancy No H/O Blood transfusions

6. General physical Examination Height 152 cm Weight 61 kg BMI – 26.4 PR 78 bpm Bp 140/90 mmhg Pallor+ Systemic Examination: R/S- B/L equal VBS, no added sounds P/A- Soft Non tender

7. 04/06/2022 Blood Group A positive Haemoglobin 9.7 g/dl Total Leucocyte count 7900 (N-56%, L-35%) cells/mm3 Platelets 2.1 lakh/mm3 Peripheral smear Normocytic normochromic TSH 1.43 mIU /L Serum creatinine 8.4 mg/dl Serum sodium 140 mEq/L Serum potassium 6.0 mEg/L Serum calcium 8.2 mg/dl Serum phosphorus 9.2 mg/dl Serum uric acid 5.6 mg/dl HbA1c 5.5

8. PT/INR 13.2/13.6/0.97 seconds APTT 30.5/29.4 LFT Total Bilirubin 0.1 SGOT-21, SGPT- 20 Total protein- 6.8, albumin 4.1, Globulin-2.7 ALP 221, Lipid Profile Total Cholesterol- 181, HDL- 43, LDL-114 Triglycerides-122 HIV Negative HBSAg , HCV Nonreactive Hep B core antibody Negative CMV IgM, IgG 0.14 Negative, 61- Positive

9. CEA—1.63 CA-125 <5.5 LDH -146 Alpha feto protein –2,.52 CUE: 04/06/22 pH- Neutral Specific Gravity- 1.010 Protein- nil Sugar- nil WBC- 1-2 RBC-nil

10. CT ABDOMEN PLAIN: 08 /06/2022 Liver- 12 cm, Normal echotexture Gall bladder- Normally distended Spleen- 9.1 cm, normal in size and parenchymal echotexture Pancreas: Normal Right kidney measures NOT VISUALISED, Left kidney grossly small 4.5*3 cm with increased echotexture Uterus –normal, ovaries- Right ovary- smooth walled benign physiological cyst 50*39mmin size Left ovary- 29*32 mm cyst Iliofemoral Doppler- Normal Iliofemoral vessels

11. Cardiology -Cleared by Dr Pankaj Jariwala with intermediate cardiac risk. ECG Poor R wave progression 2D echo Rheumatic heart disease Moderate MR, No MS Normal LV systolic function Mild AR, Mild TR, Mild PAH (RVSP= 39 mmHg) Inj Penidura prophylaxis 12 lakh IU IM 3 weekly post transplant CLEARENCES

12. Pulmonology- Cleared by Dr Nagarjuna Maturu Chest Xray –WNL PFT –Normal Gastroenterolgy – Cleared by Dr. Akash Chaudhary with explained risk UGIE- Erosive antral gastritis, Anti Hbc – negative Gynecology– Cleared by Dr. Sarada M Pap smear- negative for intraepithelial lesion or malignancy Urology PAC and Dental Pending

13. Blood transfusions Vaccination LMP