Open Resources and Online MSc from the University of Edinburgh and RCPE

Another visit to the transplant clinic

Heart surgery

A 53 year old teacher is seen for routine follow up in the transplant clinic. She underwent successful cadaveric renal transplantation just under two years ago having developed ESRF secondary to IgA nephropathy. She had a stormy course post-operatively with an episode of rejection in the immediate post-transplant period. She later became unwell following infection with cytomegalovirus (CMV).

 

What viral infections are of a particular concern in patients who have undergone renal transplantation and what problems can they cause?

IM students, add your thoughts to this week’s discussion board.

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Renal failure from the HIV clinic

You are working in Blantyre, Malawi. A 32 year old man presents with 3 days of vomiting, nausea, and malaise.  HIV was diagnosed 6 months ago but he has not been started on anti-retroviral therapy.  He has no other significant past medical history.

He is apyrexial.  BP is 100/60 and pulse 82.  He has no oedema.  JVP is not visible when lying flat.

Urine dipstick shows 1+ protein only.  The only other investigation available is serum creatinine – 700 micromol/l (8 mg/dl).

 

 

 

  • What do you think are the main diagnostic possibilities here?
  • What additional key questions would you like to ask?
  • What would your initial management be?

MSc students put your thoughts up on the discussion board.

Thanks to Gavin Dreyer, Francesca Th’ng and Neil Turner for this case.