IPLab:Lab 6:Chronic Rejection

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Clinical Summary

This 39-year-old male had malignant hypertensionHypertension which has caused end-organ damage is termed malignant. Without proper treatment, these patients will usually die in less than 2 years. Blood pressures in patients with malignant hypertension are frequently 160/110 mm Hg or greater. with malignant nephrosclerosis, progressing to chronic renal failureRenal failure is the severe reduction of renal function and often leads to reduced urinary output.. He underwent a bilateral nephrectomy for control of his hypertension and received a cadaveric renal transplant. He did well, although he developed diabetes mellitus and had persistent, but less severe controllable hypertension. Two years following transplantation he was admitted to the hospital for control of his hypertension and evaluation of his chronic rejection. Initial blood pressure while in the hospital was in the range of 160/110 to 160/100 mm Hg. He was placed on a more intensive hypertension regimen, and he gradually became normotensive. He received one hemodialysis treatment prior to discharge. At the time of discharge, his blood pressure was 100 to 110 over 60 to 70 and he was doing well on dialysis. His BUN was 113 mg/dLA normal BUN for this patient would be 10 to 20 mg/dL. and creatinine 5.2 mg/dLThe normal creatinine level is 0.7 to 1.3 mg/dL., and he had a hematocrit (PCV) of 27%A normal hematocrit for a male is 39 to 49%.. The patient was again admitted one month later for evaluation of azotemiaAzotemia is a condition of having excess nitrogen in the blood--a good indicator of reduced kidney function. and for control of his hypertension. It was felt that his chronic rejection was end-stage and that he would have to be dialyzed periodically. He was put on a renal failureRenal failure is the severe reduction of renal function and often leads to reduced urinary output. diet, and over the period of his hospitalization, his BUN and creatinineThese tests are measures of kidney function. High levels mean low function. finally stabilized at high levels. He tolerated dialysis well, and a transplant nephrectomy was done at 2 1/2 years post transplant. At the time of discharge, the patient's BUN was 78 mg/dL, creatinine 3.6 mg/dL, WBC 5000 cells/mm³A normal white blood cell count is 4000-11,000 cells/mm³., and the PCV was 26A normal partial thromboplastin time is 28 to 37 seconds.%.

Surgical Pathology Findings

The kidney weighed 215 gramsA normal kidney weighs 157 grams (range: 115 to 220 grams). and was covered by a thick capsule, which was partially adherent to the cortex, but could be stripped from the kidney with slight difficulty. The calyces and pelvis of the kidney appeared normal. The vessels were not prominent. The renal arteries and vein appeared normal.

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