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Renal Case #2

authored by Margaret McDougal, M.D., Ph.D. (c) 1997
used with permission

edited by Michael Gordon, Ph.D.

  • A 40 year old black man with end-stage renal disease requiring dialysis for 6 years receives a cadaveric kidney transplant.
  • Post-transplant, he has some problems with rejection, requiring large doses of steroids for control.
  • He is discharged from the hospital 3 weeks after transplantation with a serum creatinine of 2.6 mg/dL.
  • His discharge medications include cyclosporine (Sandimmune, Neoral), azathioprine (Imuran), prednisone, furosemide (Lasix), amlodipine (Norvasc), and acyclovir.
  • His BP is 140/86 and his weight is 75 kg.
  • Post-transplant care occurs smoothly for several months, except that you notice that he is gaining weight.
  • Four months after transplantation, his weight is 90 kg, his BP is 160/96, he has 2+ peripheral edema, his serum creatinine is 3.0 mg/dL, and his fasting serum glucose is 210 mg/dL. In addition, he has developed an upper respiratory infection with a dry cough and fever.

What has happened to this patient? How could his medications have contributed to the problems he now has?