Case Study Analysis: Acute kidney transplant rejection

Case Study Analysis: Acute kidney transplant rejection – A 34-year-old Hispanic-American male with end-stage renal disease received a kidney transplant from a cadaver donor, as no one in his family was a good match…

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Case Study Analysis: Acute kidney transplant rejection

Paper details

A 34-year-old Hispanic-American male with end-stage renal disease received a kidney transplant from a cadaver donor, as no one in his family was a good match. His post-operative course was uneventful, and he was discharged with the antirejection drugs Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine).

He did well for 3 months and had returned to his job as a policeman. Six months after his transplant, he began to gain weight, had decreased urine output, was very fatigued, and began to run temperatures up to 101?F. He was evaluated by his nephrologist, who diagnosed acute kidney transplant rejection.

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Please be sure to read all the instructions and make sure you are using headings so that the content is clear.  Don’t forget that your paper must be in APA format, paragraphs developed, 5-6 sentences each with citations, make sure that your first paragraph has a clear purpose statement in your introduction, and review the rubric so you are clear about the expectations.

Develop a 1- to 2-page case study analysis in which you:

  • Explain why you think the patient presented the symptoms described.
  • Identify the genes that may be associated with the development of the disease.
  • Explain the process of immunosuppression and the effect it has on body systems.
  • A clear and comprehensive purpose statement, title page, introduction, summary, reference list are provided that delineate all required criteria.
  • The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

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Solution

Introduction

Acute kidney transplant rejection is a result of the body’s immune system trying to protect itself from anything foreign. The condition develops in 10-20% kidney transplantations and manifests in line with the reduced functionality of the kidney. Rejection occurs due to genetic disparity, which is countered through immunosuppressant initiated during the transplantation process or prescribed after the process.

In reference to the case of the patients with symptoms of acute kidney transplant rejection, it is imperative to examine the manifestation of the disease, trace and show the genes linked to the development of the disease and analyze immunosuppression and the impact it has on the patient’s body.

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Symptoms Presented by the Patient

Weight gain associated with high temperatures, fatigue, and decreased urine output, shows rejection of the new kidney by the body (Cashion et al., 2014). Post-transplant weight gain is associated with the use of immunosuppressive medications that protect the newly implanted kidney coupled with changes in diet and insufficient physical activity. The immune system identifies the new kidney as a foreign object and attacks it, leading to its reduced functionality.

The subsequent manifestations include fatigue, low urinal output, and Fever higher than 101F. Moreover, acute rejection manifests within a year of a transplant, with the risk being the highest within the first three months after the transplant. Kidney biopsy repeated blood work and renal ultrasound tests could help diagnose acute kidney rejection while a high dosage of the anti-rejection drug is used to manage and treat the rejection (Justiz, Waheed, Fan, Misra, & Fitzgerald, 2018).

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Genetic Disparity

The development of acute kidney transplant rejection is because of class I and class II HLA gene disparity between the donor and the receptor. Besides the matching of ABO blood group to bar the interaction of A and B on the endothelium Increase expression of HLA class I and HLA class II antigens in inflamed grafts paired with early infiltration of CD8+ cells lead to the rejection (Starzl, 2011).

Further, rejection can be a result of genetic disparity, which allows the immune system to see MHC class I and class II as foreign to the body. Antigen Presenting Cells (APC) trigger CD4+ to react to the graft kidney by producing cytokines that further trigger the immune system to attack and destroy the new organ as foreign within days.

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Immunosuppression and effects on the Patient’s Body

To limit the attacks and rejection, immunosuppression works to suppress the immune system and its ability to attack organs or infections it deems foreign. Post-transplantation, suppression by decreasing the activity of the immune system by targeting T-cells activation by either induction therapy during the transplant and up to 10 days after the transplant or by drug therapy post-transplantation.

Hence, agents such as monoclonal antibodies bind with CD3 to block T-cell activation and can be used in the initial induction therapy and the treatment of acute rejection (Naik & Shawar, 2020). Immunosuppression agents Daclizumab, basiliximab, and polyclonal antibodies can also be used in the induction therapy stages to block IL-2 binding while also binding several sites on T-cell to block activation.

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After the induction therapy approaches, immunosuppression shifts to long-term suppression and maintenance therapy with the primary goals being to ensure survival by reducing drug toxicity and side effects as well as manage the risk of infections. The anti-rejection drugs used by the patient, Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine) fall within this category.

Tacrolimus (Prograf) and Cyclosporine (Neoral) act by inhibiting IL-2 expression and lymphocyte activation while Imuran (Azathioprine) inhibits purine nucleic acid metabolism (Naik & Shawar, 2020). The latter cause GI disturbances and myelosuppression, while Tacrolimus (Prograf) and Cyclosporine (Neoral) are linked to nephrotoxicity, hypertension, and hyperglycemia.

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References

  • Cashion, A. K., Hathaway, D. K., Stanfill, A., Thomas, F., Ziebarth, J. D., Cui, Y., Cowan, P. A., & Eason, J. (2014). Pre-transplant predictors of one yr weight gain after kidney transplantation. Clinical transplantation, 28(11), 1271–1278. https://doi.org/10.1111/ctr.12456
  • Justiz. V., Waheed, A., Fan, J., Misra, S., & Fitzgerald, B. M. (2018). Acute Transplantation Rejection. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535410/
  • Naik RH, Shawar SH. Renal (2020). Transplantation Rejection. [Updated 2020 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553074/
  • Starzl, T. E., Rosenthal, J. T., Hakala, T. R., Iwatsuki, S., Shaw, B. W., Jr, & Klintmalm, G. B. (2011). Steps in immunosuppression for renal transplantation. Kidney international. Supplement, (14), S–65.

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