Group Teaching - Dialysis & Kidney Transplant

Question 1

Mr AB, 59-year-old male with a medical history of hypertension, who works as a consultant with a multinational company has to frequently travel overseas for work. While abroad, he developed gastroenteritis, resulting in 5 days of diarrhoea, vomiting and limited oral intake. He purchased ibuprofen to treat abdominal pain and headaches, which he took for 7 days. Fourteen days after symptom onset, on return to the UK, he reported to his GP complaining of loss of appetite, vomiting, chronic fatigue, swelling in ankles and breathlessness. He was referred to the nephrology clinic and initial tests revealed his GFR value was 10ml/min. Blood tests found the Blood Urea Nitrogen (BUN) was 30mg/dL, potassium was 6.2mmol/L, and serum creatinine was 1500umol/L. Both the kidneys were measured to be 8cm each through ultrasound.

What is your differential diagnosis?

Answer 1

Acute Kidney Injury

Question 2

Mr AB, 59-year-old male with a medical history of hypertension, who works as a consultant with a multinational company has to frequently travel overseas for work. While abroad, he developed gastroenteritis, resulting in 5 days of diarrhoea, vomiting and limited oral intake. He purchased ibuprofen to treat abdominal pain and headaches, which he took for 7 days. Fourteen days after symptom onset, on return to the UK, he reported to his GP complaining of loss of appetite, vomiting, chronic fatigue, swelling in ankles and breathlessness. He was referred to the nephrology clinic and initial tests revealed his GFR value was 10ml/min. Blood tests found the Blood Urea Nitrogen (BUN) was 30mg/dL, potassium was 6.2mmol/L, and serum creatinine was 1500umol/L. Both the kidneys were measured to be 8cm each through ultrasound.

Identify probable cause(s) for his disorder.

Answer 2

• Medication: NSAIDs / Metformin / SGLT2i
• Dehydration
• Infection
• Hypertnesion

Question 3

Mr AB, 59-year-old male with a medical history of hypertension, who works as a consultant with a multinational company has to frequently travel overseas for work. While abroad, he developed gastroenteritis, resulting in 5 days of diarrhoea, vomiting and limited oral intake. He purchased ibuprofen to treat abdominal pain and headaches, which he took for 7 days. Fourteen days after symptom onset, on return to the UK, he reported to his GP complaining of loss of appetite, vomiting, chronic fatigue, swelling in ankles and breathlessness. He was referred to the nephrology clinic and initial tests revealed his GFR value was 10ml/min. Blood tests found the Blood Urea Nitrogen (BUN) was 30mg/dL, potassium was 6.2mmol/L, and serum creatinine was 1500umol/L. Both the kidneys were measured to be 8cm each through ultrasound.

What treatment should be considered for Mr AB?

Answer 3

• Hydration / IV fluids
• Antibiotics
• Stop NSAIDs
• Dyalisis

Question 4

Mr AB, 59-year-old male with a medical history of hypertension, who works as a consultant with a multinational company has to frequently travel overseas for work. While abroad, he developed gastroenteritis, resulting in 5 days of diarrhoea, vomiting and limited oral intake. He purchased ibuprofen to treat abdominal pain and headaches, which he took for 7 days. Fourteen days after symptom onset, on return to the UK, he reported to his GP complaining of loss of appetite, vomiting, chronic fatigue, swelling in ankles and breathlessness. He was referred to the nephrology clinic and initial tests revealed his GFR value was 10ml/min. Blood tests found the Blood Urea Nitrogen (BUN) was 30mg/dL, potassium was 6.2mmol/L, and serum creatinine was 1500umol/L. Both the kidneys were measured to be 8cm each through ultrasound.

The consultant decided to start Mr AB on dialysis. Please research in your groups the different types of dialysis, and the considerations with each type. Submit your choice of dialysis method with reasoning.

Answer 4

• Haemodyalisis
• Peritoneal dialysis

Peritoneal dialysis: can be done at home and gives the patient more freedom

Question 5

Mr AB, 59-year-old male with a medical history of hypertension, who works as a consultant with a multinational company has to frequently travel overseas for work. While abroad, he developed gastroenteritis, resulting in 5 days of diarrhoea, vomiting and limited oral intake. He purchased ibuprofen to treat abdominal pain and headaches, which he took for 7 days. Fourteen days after symptom onset, on return to the UK, he reported to his GP complaining of loss of appetite, vomiting, chronic fatigue, swelling in ankles and breathlessness. He was referred to the nephrology clinic and initial tests revealed his GFR value was 10ml/min. Blood tests found the Blood Urea Nitrogen (BUN) was 30mg/dL, potassium was 6.2mmol/L, and serum creatinine was 1500umol/L. Both the kidneys were measured to be 8cm each through ultrasound.

After being for 2 years on dialysis, after initially refusing, Mr AB has decided to opt for kidney transplant. What factors are considered in determining a candidate as a suitable live kidney donor?

Answer 5

• Family history of kidney disease
• Age
• Two healthy kidneys
• Financial stability
• Mental health history
• Future pregnancy
• Kidney match
  
  • Blood type compatibility
  • HLA typing
  • Serum cross match
• Comorbidities

Question 6

Mr AB, 59-year-old male with a medical history of hypertension, who works as a consultant with a multinational company has to frequently travel overseas for work. While abroad, he developed gastroenteritis, resulting in 5 days of diarrhoea, vomiting and limited oral intake. He purchased ibuprofen to treat abdominal pain and headaches, which he took for 7 days. Fourteen days after symptom onset, on return to the UK, he reported to his GP complaining of loss of appetite, vomiting, chronic fatigue, swelling in ankles and breathlessness. He was referred to the nephrology clinic and initial tests revealed his GFR value was 10ml/min. Blood tests found the Blood Urea Nitrogen (BUN) was 30mg/dL, potassium was 6.2mmol/L, and serum creatinine was 1500umol/L. Both the kidneys were measured to be 8cm each through ultrasound.

Please research and list recommendations for a patient who has undergone a kidney transplant surgery to lead a healthy life while managing his condition.

Answer 6

• No live vaccines
• No alcohol
• No recreational drugs
• No NSAIDs / Herbal medicines
• No smoking
• Dietary restrictions:
  
  • No seville oranges or tacrolimus
  • No raw eggs, raw meat, undercooked fish or unpasteurised cheese