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Case Study One Pediatric Patient

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Case Study One Pediatric ... and presumed rejection Renal ultrasound was done to evaluate ... and substantial decline in renal function Discussion and ... – PowerPoint PPT presentation

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Title: Case Study One Pediatric Patient


1
Case Study One Pediatric Patients Experience
  • Shelley Chapman RN, BSN, CCTC
  • Childrens Hospital of Wisconsin

2
Patient History
  • 15 year old Caucasian male
  • Past medical history
  • Liver transplant
  • 3 year old
  • Fulminant liver failure of unknown etiology
  • Bone marrow transplant
  • 12 years old
  • Aplastic anemia
  • Kidney transplant
  • 13 years old
  • Immunosuppression

3
Patient Presentation
  • Presented to the Renal Clinic
  • 5 day history of dysuria
  • 2 day history of gross hematuria
  • Labs
  • Creatinine elevated at 1.49mg/dl
  • Increased from his baseline of 0.8mg/dl
  • Hospital admission
  • Further evaluation and presumed rejection
  • Renal ultrasound was done to evaluate for stones
  • IV fluids on the day of admission

4
Patient Presentation The Next 48 Hours
5
Patient Presentation Cont.
6
Treatment
  • Recommended treatment for Adenovirus s/p BMT
  • Cidofovir and Probenecid
  • Side effect is nephrotoxicity
  • Alternate prodrug formulation of Cidofovir
    (CMX001) recommended
  • Drug currently in clinical trials

7
Treatment Continued
  • The Adenovirus PCR peaked at 137,000 copies
  • Slowly improved
  • Experienced intermittent fevers without
    bacteremia
  • Immunosuppression changes
  • DC Mycophenolate Mofetil
  • Continued on Tacrolimus and Prednisone
  • Patient discharged to home after 10 days

8
Outpatient Treatment Follow-up
9
1 Year Follow-up
10
Lessons Learned
  • Do not assume patient is having rejection with
    sudden and substantial decline in renal function

11
Discussion and Questions
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