A 34-year-old Hispanic-American Male with End-stage Renal Disease Essay

Why the Patient Presented the Symptoms

The patient presented with the symptoms because of acute graft rejection (chronic rejection). Chronic rejection normally occurs more than three months after the kidney transplant, and it can be chronic T cells mediated rejection or chronic antibody-mediated rejection (McCance & Huether, 2019). This is a chronic rejection because the patient started manifesting symptoms after six months. Symptoms such as weight gain are because of fluid retention, reduced urine output is due to deteriorating renal function, while fever is due to infection because of immunosuppression.

Genes Associated with the Development of the Disease

The genes associated with acute rejection include CE (rs4340), CCR5 (rs1799987), rs231775), CCR2 (rs1799864), CTLA4 (rs5742909, CD28C (rs3116496), IL10 (rs1800896, rs1800872, and F5 (rs6025) (Dorr et al., 2018). These genes are important in Tacrolimus (TAC) metabolism and vary substantially by race. TAC is the primary immune suppressant utilized during kidney transplants to prevent acute rejection and differs in efficacy in different populations (Dorr et al., 2018). The rejection is thus due to nonimmune and immune-mediated factors where for this patient, the primary risk factor for the transplant rejection is non-compliance with the immunosuppressive drug (TAC) due to the associated genes.

The Process of Immunosuppression and the Effect on the Body Systems

The immunosuppression process includes administration of medications such as corticosteroids, cyclosporine, rapamycin, azathioprine; administration of certain antibodies; or the use of irradiation in order to depress immune reactivity in recipients who undergo organ allotransplants (Cangemi et al., 2019). Immunosuppression lowers the immunity of an individual and hence increases the susceptibility of such a person to infections and diseases.

References

Cangemi, M., Montico, B., Faè, D. A., Steffan, A., & Dolcetti, R. (2019). Dissecting the Multiplicity of Immune Effects of Immunosuppressive Drugs to Better Predict the Risk of de novo Malignancies in Solid Organ Transplant Patients. Frontiers in oncology, 9, 160. https://doi.org/10.3389/fonc.2019.00160

Dorr, C. R., Oetting, W. S., Jacobson, P. A., & Israni, A. K. (2018). Genetics of acute rejection after kidney transplantation. Transplant international: official journal of the European Society for Organ Transplantation, 31(3), 263–277. https://doi.org/10.1111/tri.13084

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

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Scenario 3: A 34-year-old Hispanic-American male with end-stage renal disease received 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.

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.
Heading for each question.

Readings
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Chapter 1: Cellular Biology; Summary Review
Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents(pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases,
Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
Chapter 7: Innate Immunity: Inflammation and Wound Healing
Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
Chapter 10: Infection (stop at Infectious parasites and protozoans); (start at HIV); Summary Review
Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review
Note: You previously read these chapters in Week 1 and you are encouraged to review once again for this week.
Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/
​Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls.

Note: This article was presented in the Week 1 resources. If you read it previously you are encouraged to review it this week.
Required Media (click to expand/reduce)
Foundational Concepts of Cellular Pathophysiology – Week 2 (8m)

Immunity and Inflammation

Khan Academy (2010, February 24). Inflammatory response | Human anatomy and physiology | Health & medicine [Video file]. Retrieved from https://www.youtube.com/watch?v=FXSuEIMrPQk
Note: The approximate length of the media program is 14 minutes.
Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file]. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds
Note: The approximate length of the media program is 37 minutes.
Acid-Base Balance #1

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MedCram. (2012, April 28). Medical acid base balance, disorders & ABGs explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=4wMEMhvrQxE
Note: The approximate length of the media program is 13 minutes.
Acid-Base Balance #2

MedCram. (2012, April 29). Medical acid base balance, disorders & ABGs explained clearly | 2 of 8 [Video file]. Retrieved from https://www.youtube.com/watch?v=GmEeKVTpOKI
Note: The approximate length of the media program is 15 minutes.
Hyponatremia

MedCram. (2017, December 23). Hyponatremia explained clearly [LK1] (remastered) – Electrolyte imbalances [Video file]. Retrieved from https://www.youtube.com/watch?v=bLajK5Vy55M
Note: The approximate length of the media program is 15 minutes.

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