6501 Module 1 week 2 Assignment- Case Study Analysis

Acute kidney transplant rejection can hinder the kidney’s ability to regain function even with maximum therapy for antirejection. Even among patients who recover, episodes of acute rejection can influence long-term graft survival negatively. Rahimi et al. (2017) highlight acute rejection as a key predictor of tubular atrophy and interstitial fibrosis often referred to as chronic allograft nephropathy, which accounts for the majority of the graft loss associated deaths the first year after transplantation. However, over the decades, incidences of acute kidney transplant rejection continue to decline due to the use of highly potent immunosuppressive drugs. This paper reviews a case study of a 34-year-old Hispanic male who was diagnosed with acute kidney transplant rejection and describes the pathophysiology of acute kidney transplant rejection. It also describes the genes associated with the development of the disease, the process of immunosuppression, and its effect on body systems. 6501 Module 1 week 2 Assignment- Case Study Analysis.

Why the Patient Presented With the Symptoms Described

The patient presented with the symptoms described due to cell-mediated injury involving both the arterial and tubule-interstitial components. Foreign (donor) antigens in the transplanted kidney activate the recipient’s lymphocytes through the antigen-presenting cells (APC) in semi-direct, direct, and indirect-pathways. This process activates and infiltrate the T-cells and damage the transplanted kidney (Bijkerk et al., 2017). These cells cross the donor’s kidney micro-circulatory system to enter the interstitium influencing the release of cytokines such as the TGF-beta (transforming growth factor-beta) and interferon-gamma (IFN-γ). This process triggers an inflammatory cascade resulting in reduplication of the glomerular basement membrane, a hallmark feature of acute transplant kidney rejection and symptoms such as oliguria (decreased urine output) (Bijkerk et al., 2017). The most likely cause of weight gain was a change in lifestyle (physical inactivity and post-transplant diet).

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Genes Associated With the Development of the Disease

Class II HLA and class I genes are associated with acute kidney transplant rejection. Although an ABO match safeguards against an acute transplantation rejection, when there exists a disparity between the donor and recipient, rejection occurs when the memory cells that function against the alloantigen’s in the graft differentiate further into Th1 and Th2 lymphocyte (Justiz, Misra & Fitzgerald, 2020). This produces gamma interferons and IL-2, which mediate cellular immune responses. IL-4, 5, 6, 7, 8, 9 and 10 are produced by Th 2 cells stimulating antibody-mediated humoral responses. The Th-1 cells cause acute rejection when they receive antigens from antigen-presenting cells. Other subsets that can be involved in the development of the disease by participating in the inflammatory cascade are Th9, Th17, and Th22 (Justiz, Misra & Fitzgerald, 2020).

Process of Immunosuppression and the Effect on the Body Systems

Shrestha (2017) describes immunosuppression as a decrease in the efficacy of the activation of the immune system. It may be due to the treatment of an underlying condition, or an adverse reaction. In the context of an organ transplant, immunosuppression occurs when healthcare providers administer immunosuppressive drugs to prevent the body from rejecting an organ transplant and the drugs target only hyperactive components of the immune system (Shrestha, 2017). 6501 Module 1 week 2 Assignment- Case Study Analysis. After a transplant, the body often tries to reject an organ due to variations in the human leukocyte antigen that may exist between a recipient and a donor. The immune system detects the transplanted organ as a ‘foreign’ object and may attempt to remove it by attacking white blood cells causing the death of the donated organ. However, immunosuppressants increase the body’s vulnerability to malignancy and infections.

Conclusion

Although a kidney transplant is the only form of therapy for ESRF, acute kidney transplant rejection can occur when the immune system considers the grafted kidney as a foreign object and attacks it, causing destruction and ultimately, rejection. The patient presented with the symptoms of weight gain, decreased urine output, chronic fatigue, and temperatures as high as 101˚F due to a cell-mediated injury that involved both the arterial and tubule-interstitial components that caused damage to the transplanted kidney. Class II HLA and class I genes are the genes associated with the development of rejection when Th-1 cells receive antigens from antigen-presenting cells.

References

Bijkerk, R., Florijn, B. W., Khairoun, M., Duijs, J., Ocak, G., de Vries, A., Schaapherder, A. F., Mallat, M., de Fijter, J. W., Rabelink, T. J., van Zonneveld, A. J., & Reinders, M. (2017). Acute Rejection after Kidney Transplantation Associates with Circulating MicroRNAs and Vascular Injury. Transplantation direct, 3(7), e174. https://doi.org/10.1097/TXD.0000000000000699

Justiz V.A., Misra S., & Fitzgerald B.M., (2020). Acute Transplantation Rejection. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Available from https://www.ncbi.nlm.nih.gov/books/NBK535410/

Rahimi, M. M., Alizadeh, M., Taghizadeh Afshari, A., Valizadeh, R., Zakeri, R., Jafarzadeh Kohneloo, A., & Mohammadi Fallah, M. R. (2017). Prevalence, causes, and complications of acute kidney transplant rejection: a survey in a single center. Internal Medicine and Medical Investigation Journal, 2(4), 139-142. 6501 Module 1 week 2 Assignment- Case Study Analysis.

Shrestha, B. M. (2017). Immune system and kidney transplantation. Apoptosis, 8, 11.

Module 1 Assignment: Case Study Analysis

An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.

Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.

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An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health.

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To prepare:

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

The Assignment (1- to 2-page case study analysis)

Develop a 1- to 2-page case study analysis in which you:

• Explain why you think the patient presented the symptoms described.
• Identify the genes that may be associated with the development of the disease.
• Explain the process of immunosuppression and the effect it has on body systems. 6501 Module 1 week 2 Assignment- Case Study Analysis.

CASE STUDY

Scenario: A 34-year-old Hispanic-American male with the end-stage renal disease received a kidney transplant from a cadaver donor, as no one in his family was a good match. His postoperative course was uneventful, and he was discharged with the antirejection drugs Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine). He did well for 3 months and had returned to his job as a policeman. Six months after his transplant, he began to gain weight, had decreased urine output, was very fatigued and began to run temperatures up to 101˚F. He was evaluated by his nephrologist, who diagnosed acute kidney transplant rejection.

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6501 Module 1 week 2 Assignment- Case Study Analysis