Kidney Transplantation, Hope to Life: Case Study Desperate Diseases Require Desperate Remedies

Transcription

1 Human Jurnals Case Study September 2017 Vl.:10, Issue:2 All rights are reserved by Supriya et al. Kidney Transplantatin, Hpe t Life: Case Study Desperate Diseases Require Desperate Remedies Keywrds:Kidney transplantatin, uraemic patients, CKD ABSTRACT Supriya Ex. Registered Dietician Intern Apll Hspital, Bengaluru Submissin: 23August 2017 Accepted: 29 August 2017 Published: 30September Intrductin: Kidney transplantatin has cme as a hpe fr patients suffering frm End Stage Kidney Disease. Successful kidney transplantatin imprves the quality f life and prlngs the survival f uraemic patients cmpared t lng term dialysis patients. Case Presentatin: Patient is 28 years male is hypertensive, CKD 5 detected in May 2013 since then n maintenance hemdialysis came up fr renal transplant with wife as ptential dnr. Management: He was induced with ATG and triple immunsuppressin. Right sided Renal transplant was dne n 29/07/13. Right kidney f dnr was placed in right iliac fssa and vascular anastmses dne t external iliac vessels. Ureter stent was placed. Stent remval after three weeks. Staple remval n 09/08/13. Diuresis was brisk and immediate.cnclusin: Pst-perative perid was uneventful, tubes, drain were remved as per prtcl and S.creatinine at discharge was 1.34 mg/dl. Surgical wund is clear and vitals are stable. He was discharged in stable cnditin with prescribed lw salt diet. Nutritinal therapy is essential in patients with kidney transplant. Nutritin cunseling was dne.

2 INTRODUCTION Kidney transplantatin has cme as a hpe fr patients suffering frm End Stage Kidney Disease. Successful kidney transplantatin imprves the quality f life and prlngs the survival f uraemic patients cmpared t lng term dialysis patients CASE PRESENTATION Patient is 28 years male is hypertensive, CKD 5 detected in May 2013 since then n maintenance hemdialysis came up fr renal transplant with wife as ptential dnr. MANAGEMENT He was induced with ATG and triple immunsuppressin. Right sided Renal transplant was dne n 29/07/13. Right kidney f dnr was placed in right iliac fssa and vascular anastmses dne t external iliac vessels. Ureter stent was placed. Stent remval after three weeks. Staple remval n 09/08/13. Diuresis was brisk and immediate. Risks f the prcedure Bleeding Infectin Blckage f the bld vessels t the new kidney Leakage f urine r blckage f urine in the ureter Initial lack f functin f the new kidney Befre the prcedure Psychlgical and scial evaluatin Psychlgical and scial issues invlved in rgan transplantatin, such as stress, financial issues, and supprt by family and/r significant thers are assessed. Bld tests Bld tests are perfrmed t help determine a gd dnr match, t assess yur pririty n the dnr list and t help t imprve the chances that the dnr rgan will nt be rejected. Citatin: Supriya et al. Ijppr.Human, 2017; Vl. 10 (2):

3 Diagnstic tests Diagnstic tests may be perfrmed t assess yur kidneys as well as yur verall health status. These tests may include X-rays, ultrasund prcedures, kidney bipsy. After the prcedure Patient will have a catheter in yur bladder t drain yur urine. The amunt f urine will be carefully measured t evaluate the new kidney's functin. Patient will receive IV fluids until yu are able t take in adequate fd and fluids. Patient immunsuppressin (antirejectin) medicatins will be clsely mnitred t make sure yu are receiving the ptimum dse and the best cmbinatin f medicatins. Living with a transplant It s recmmended that yu: quit smking if yu smke eat a healthy diet lse weight if yu are verweight r bese; ideally yu want t achieve a bdy mass index f less than 25. There are tw main treatment ptins when it is knwn kidney failure is likely t ccur: Dialysis, where a mechanical device is used t replicate the functins f the kidney Kidney transplant, which, if pssible, is usually the preferred ptin because it is much less incnvenient than having dialysis. Bld clts Widely used immunsuppressants are: tacrlimus ciclsprin sirlimus azathiprine Citatin: Supriya et al. Ijppr.Human, 2017; Vl. 10 (2):

4 mycphenlate prednislne MEDICATION HISTORY MEDICINE DOSE FREQUENCY PURPOSE Inj Magnex Frte 1.5gm T treat systemic infectin Inj Cefazlin 1 gm Antibitic Inj Slumedrl 1 gm OD Immunsuppressive Inj Emeset 4 mg T stp vmiting Inj Calcium Glucmate 10 % NS T prevent lack f calcium Inj Magnesium sulphate 50 % OD T prevent lw magnesium level Tab Sandcl 500 mg Calcium supplementatin Tab Nicardia 20 mg T treat high bld pressure Tab Myfrtic 360 mg Immunsuppressive Tab Tacrgraf 2 mg Immunsuppressive Tab Omnacrtil 20 mg Anti - inflamatry Surgery: Prcedure dne n 29 th July, 2013 BIOCHEMICAL PARAMETERS PARAMETER RESULT NORMAL RANGE Haemglbin 12.5 gm/dl FBS 95 mg/dl S. SGPT 8 U/L 5 40 S.SGOT 10 U/L 5 45 S. Urea 35 mg/dl S. Creatinine 7.4 mg/dl S. Sdium 138 mml/l S. Ptassium 4.2 mml/l TSH 0.39 uiu/ml Citatin: Supriya et al. Ijppr.Human, 2017; Vl. 10 (2):

5 24 HOUR DIETARY RECALL MEAL MENU AMT ENERGY (kcal) CHO (gm) PROTEIN (gm) FAT (gm) Early mrning Tea(with sugar) 100 ml Breakfast Idli Sambhar 1 bwl Lunch Rice 11/2 cup Dal 1 bwl Refreshment Tea(with sugar) 100 ml Dinner Rice 1 cup Dal 1 bwl Vegetable 1 bwl Ttal GOAL OF MEDICAL NUTRITION THERAPY Calries, prtein, fluid, vitamins and minerals are necessary t regain yur immunity, maintain r achieve yur weight gal, strengthen yur muscles. Yur gal is t maintain r achieve an apprpriate weight fr yur bdy size. It is imprtant t cnsume a nutritius diet, including a variety f fds, t prmte recvery f yur immune system. A high fluid intake helps flush yur kidneys when yu take medicatins that can impair kidney functin, including Cyclsprine & Tacrlimus antibitics. A high salt intake can wrsen fluid retentin caused by predniselne. Avid salt and salty fds, such as canned, instant and frzen sups and entrees; sy sauce; cured meats and packaged sauces and seasnings. T prevent frm further cmplicatin. NUTRITIONAL REQUIREMENT Energy : 2000 Kcal Citatin: Supriya et al. Ijppr.Human, 2017; Vl. 10 (2):

6 Prtein Fat Carbhydrate : 114 gm : gm : 300 gm Diet at hspital Date Diet Energy (kcal) Prtein (gm) 28/07/13 Lw salt renal sft diet /07/13 NPO /07/13 Lw salt renal sft diet /08/13 Lw salt renal sft diet /08/13 Lw salt renal sft diet /08/13 Lw salt renal sft diet DISCHARGE MEDICATION MEDICINE DOSE FREQUENCY PURPOSE Tab Omnacrtil 20 mg Anti - inflamatry Tab Tacrgraf 2 mg Immunsuppressive Tab Myfrtic 360 mg Immunsuppressive Tab Septram SS Antibitic Tab Nicardia R 20 mg T treat high bld pressure??arkamin 0.1 mg T treat high bld pressure CONCLUSION Pst-perative perid was uneventful, tubes, drain were remved as per prtcl and S.creatinine at discharge was 1.34 mg/dl. Surgical wund is clear and vitals are stable. He was discharged in stable cnditin with prescribed lw salt diet.nutritinal therapy is essential in patients with kidney transplant. Nutritin cunseling was dne. RECOMMENDATION Yu must nt take any medicine r nutritinal supplement that is nt apprved by a transplant physician because f the risk f interactin with yur immunsuppressive Citatin: Supriya et al. Ijppr.Human, 2017; Vl. 10 (2):

7 (antirejectin) medicatins.rutine Fllw-up care shuld be fllwed by transplant patient. Shuld fllw nutritinal guidance Avid feasting r fasting D nt eat leftvers Avid packed beverages, fd items and canned fds A small amunt f fd and drink that high in fat and sugar Avid fd that cntains high levels f salt, as salt can raise yur bld pressure, which can be dangerus in peple with a kidney transplant REFERENCES 1. Schnuelle P, Lrenz D, Trede M, van der Wude FJ. Impact f renal cadaveric transplantatin n survival in end-stage renal failure: evidence f reduced mrtality risk cmpared with hemdialysis during lng-term fllw-up. J Am Sc Nephrl 1998;9: Lufft V, Kliem V, Tusch G, Dannenberg G, Brunkhrst R. Renal Transplantatin in lder adults: is graft survival affected by age? A case cntrl study. Transplantatin 2000; 69: Meier-Kriesche H, Prt FK, Oj AO et al. Deleterius effects f waiting time n renal transplant at utcme. Transplant Prc 2001; 33: Citatin: Supriya et al. Ijppr.Human, 2017; Vl. 10 (2):