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Chief Complaint

Kidney transplantation

History of Present Illness

A 38-year-old patient who previously evaluated and accepted for kidney transplantation was called for a potential deceased kidney transplant. His past medical history is significant for chronic kidney disease, stage V, of unclear etiology which was diagnosed 15 years ago by lab values. He did not recall undergoing a renal biopsy. He is currently on CAPD. Dialysis was started on 9/2020 and is currently performed CAPD every night through a peritoneal catheter placed in the LLQ. He makes “more than one liter” of urine daily. He had a hypertensive emergency 9 years ago. History of acute gouty arthritis and questionable acute gout attack in his feet 9 years ago. No recurrence since. There is no past medical history for coronary artery disease, peripheral vascular disease, cerebral vascular disease, or malignancies.

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. What are the patient’s risk factors for development of rejection post-transplant?

    Hint: See Pathophysiology in PPP

  2. What therapeutic options are available for the prevention of rejection and treatment of acute and cellular rejections

    Hint: See Treatment in PPP

  3. What clinical and/or laboratory parameters should be monitored to determine acute rejection?

    Hint: See Table 55-1 in PPP

  4. How long each treatment should be continued and monitored in this patient?

    Hint: See Treatment in PPP

  5. What is the “best option” in prevention of early acute rejection?

    Hint: See Treatment in PPP


The patient has been started on appropriate immunosuppressive protocol. At follow-up, what if the patient had come into clinic with complaints of edema, fluid retention, high blood pressure for the past week. How would these clinical presentations change the management of this patient?

Hint: See Treatment in PPP


Global Perspective

Kidney transplantation is considered the treatment of choice for management of end stage kidney disease. Due to significant advanced in the understanding field of immunobiology of acute rejection, post-operative care, and immunosuppressive therapy, transplant recipients have an improved quality of life in addition to survival benefits compare to other treatment modalities (dialysis). Each patient should be assessed for the risk of acute and chronic rejections and immunosuppressive protocol should be tailored to patient’s specific risk factors. Previous transplants, preformed antibodies, positive B cell cross match and delayed graft function might increase the risk of acute rejection early post-transplant period. Number of randomized and clinical observational studies have demonstrated a clear relationship between early rejection and long-term allograft failure. Induction therapy with polyclonal antibodies such as thymoglobulin ...

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