Acute Allograft Failure Nearly a Decade Posttransplantation

作者：Christie Emily^*; Campbell Patricia; Moore Ronald; McNally Dermot; Wen Kevin C

来源：American Journal of Kidney Diseases, 2017, 70(3): IX-XI.

DOI：10.1053/j.ajkd.2017.05.015

A 72-year-old woman with end-stage renal disease secondary to diabetic nephropathy, who had received a deceased donor kidney transplant 9 years ago, presented to the emergency department via ambulance with 5 days of shortness of breath, paroxysmal nocturnal dyspnea, and abdominal bloating. On examination, blood pressure was 152/70 mm Hg, heart rate was 65 beats/min, oxygen saturation was 94% with 4 L of oxygen by nasal prongs, jugular venous pulse was elevated, and peripheral edema was noted to midshins bilaterally. Chest radiograph showed bilateral pleural effusions and pulmonary edema. She was admitted to the hospital on the cardiology service for management of heart failure. Her medical history was significant for hypertension, smoking, chronic obstructive pulmonary disease, coronary artery disease, and peripheral vascular disease with stenting to the left common iliac for claudication 7 years ago.
The patient's current drug regimen included tacrolimus, mycophenolate, and prednisone for immunosuppression and several antihypertensive medications (enalapril, metoprolol, clonidine, amlodipine, and furosemide). Brain natriuretic peptide concentration was significantly elevated (12,713 ng/L; reference range, <= 300 ng/L), as was troponin T concentration (31 ng/L [ high sensitivity]; reference range, 1-14 ng/L). An electrocardiogram and echocardiogram revealed left ventricular hypertrophy but no new abnormalities. She developed an acute decline in transplant Fig 1) with a bland urinalysis result. An ultrasound of the renal transplant revealed no hydronephrosis, with borderline increased resistive indexes. One week after admission, she became anuric, necessitating institution of hemodialysis.

• 出版日期2017-9