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.

QUESTION

CASE STUDY ANALYSIS

The Assignment

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

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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.
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· 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.

· Refer to the rubric for information required within your paper

Case scenario

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.

GRADING RUBRIC

Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:Explain why you think the patient presented the symptoms described. = The response accurately and thoroughly describes the patient symptoms. … The response includes accurate, clear, and detailed reasons, with explanation for the symptoms supported by evidence and/or research, as appropriate, to support the explanation.

Identify the genes that may be associated with the development of the disease. = The response includes an accurate, complete, detailed, and specific analysis of 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. = The response includes an accurate, complete, detailed, and specific explanation of the process of immunosuppression and the effect it has on body systems.

Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. = Paragraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation. = Uses correct grammar, spelling, and punctuation with no errors.

Written Expression and Formatting – 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. Uses correct APA format with no errors.

ANSWER

Case Study Analysis: Acute Kidney Transplant Rejection

Introduction

This case study analysis focuses on a 34-year-old Hispanic American male who received a kidney transplant from a cadaver donor due to end-stage renal disease. The patient experienced post-operative success but later presented with symptoms indicative of acute kidney transplant rejection. This analysis aims to explain the reasons behind the patient’s symptoms, identify potential genes associated with the development of the disease, and elucidate the process of immunosuppression and its effects on the body systems.

Explanation of Patient Symptoms

The presented symptoms of weight gain, decreased urine output, fatigue, and elevated body temperature (up to 101˚F) are consistent with acute kidney transplant rejection. The rejection occurs when the immune system recognizes the transplanted kidney as foreign and mounts an immune response against it. This leads to inflammation and damage to the transplanted organ, resulting in impaired kidney function (Kuan & Schwartz, 2021). Symptoms such as weight gain can be attributed to fluid retention caused by compromised renal function. Reduced urine output is a consequence of the kidneys’ inability to adequately filter and excrete waste products, leading to accumulation within the body. Fatigue may be a result of anemia or electrolyte imbalances associated with kidney dysfunction, while elevated body temperature indicates an inflammatory response.

Identification of Genes Associated with Disease Development

Several genes may play a role in the development of acute kidney transplant rejection. The major histocompatibility complex (MHC) genes, specifically human leukocyte antigen (HLA) genes, are crucial in determining the compatibility of donor and recipient tissues. Variations in these genes can increase the risk of immune recognition and rejection. Additionally, genes involved in the regulation of the immune response, such as cytokines and chemokines, may influence the susceptibility to rejection (Nakamura et al., 2019). Polymorphisms in genes encoding pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), have been associated with an increased risk of rejection.

Explanation of Immunosuppression and its Effects on Body Systems

Immunosuppression refers to the intentional suppression of the immune system to prevent the rejection of transplanted organs. In the case of this patient, immunosuppression was achieved through the administration of Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine). These medications act by inhibiting various components of the immune response, such as T-cell activation and proliferation (Duncan & Wilkes, 2005). By dampening the immune response, these drugs decrease the likelihood of the immune system identifying the transplanted kidney as foreign.

However, immunosuppression can have adverse effects on different body systems. The most significant risk is an increased susceptibility to infections due to the decreased ability of the immune system to effectively combat pathogens. Other potential effects include metabolic abnormalities, such as hyperlipidemia and diabetes mellitus, which can result from the use of certain immunosuppressive agents. Moreover, long-term immunosuppression can lead to an increased risk of developing malignancies, as immune surveillance against cancer cells is compromised.

Conclusion

In conclusion, the patient’s symptoms are indicative of acute kidney transplant rejection, which occurs when the immune system mounts an immune response against the transplanted kidney. Genes associated with the development of the disease include HLA genes and those involved in regulating the immune response. Immunosuppression, achieved through the administration of specific medications, inhibits the immune response and reduces the risk of rejection. However, it also poses risks such as infections, metabolic abnormalities, and an increased susceptibility to malignancies. Understanding these factors is crucial in managing transplant recipients and ensuring optimal outcomes.

References

Duncan, M. J., & Wilkes, D. S. (2005). Transplant-related Immunosuppression: A Review of Immunosuppression and Pulmonary Infections. Proceedings of the American Thoracic Society, 2(5), 449–455. https://doi.org/10.1513/pats.200507-073js 

Kuan, K. K. Y., & Schwartz, D. K. (2021). Educational Case: Kidney Transplant Rejection. Academic Pathology, 8, 23742895211006830. https://doi.org/10.1177/23742895211006832 

Nakamura, T., Shirouzu, T., Nakata, K., Yoshimura, N., & Ushigome, H. (2019). The Role of Major Histocompatibility Complex in Organ Transplantation- Donor Specific Anti-Major Histocompatibility Complex Antibodies Analysis Goes to the Next Stage -. International Journal of Molecular Sciences, 20(18), 4544. https://doi.org/10.3390/ijms20184544 

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