Clinical Case Database / Category: Patient Management

Infections in renal transplantation

Publication details

Prof Sunil Bhandari, Dr Adam D Jakes, Poonam Jani
Foundation Years Journal, volume 8, issue 4, p.26 (123Doc Education, London, April 2014)

Abstract

A 48 year old gentleman with adult polycystic kidney disease received a deceased donor renal transplant. His maintenance immunosuppressive therapy was tacrolimus and mycophenolate mofetil. He presented 8 months post-transplantation with fever and profuse diarrhoea for the previous 5 days (no blood), abdominal pain and lethargy. Initial investigations demonstrated an acute increase in serum creatinine from his baseline, together with a low white cell count and platelets. Here we discuss common infections in renal transplantation patients.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

ProductPriceSubscription
Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart

Authors

Prof Sunil Bhandari

Consultant Nephrologist, Honorary Clinical Professor,
Deputy Head of School of Medicine, Yorkshire Deanery,
Hull & East Yorkshire Hospitals NHS Trust,
Anlaby Road, Kingston Upon Hull, HU32JZ
sunil.bhandari@hey.nhs.uk

Dr Adam D Jakes

Academic Foundation Doctor, St James’s Univeristy Hospital,
Beckett Street, Leeds, West Yorkshire, LS9 7TF
adam.jakes@hyms.ac.uk

Poonam Jani

Medical Student, Hull-York Medical School, Hertford Building,
University of Hull, Hull, HU6 7RX
poonam.jani@hyms.ac.uk

References

1. UK Transplant Registry. Organ Donation and Transplantation Activity Data: United Kingdom. April 2013.
2. J, Douglas Briggs. Causes of death after renal transplantation. Nephrol Dial Transplant (2001) 16: 1545 – 1549.
3. Akbar SA, Jafri ZH, Amendola MA, et al. Complications in renal transplantation. Radiographics 2005; 25:1335-1356
4. Takai K, Tollemar J, Wilczek HE, Groth CG. Urinary tract infections following renal transplantation. Clin Transplant 1998;12(1): 19-23.
5. Dantas SRPE, Kuboyama RH, Mazzali M et al. Nonsocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect 2006; 63:117-123.
6. Pillay D, Mutimer D , Singhal S, Turner A, Ward K, and Wood M. 2000. Management of herpes virus infections following transplantation. J. Antimicrob. Chemother. 45:729–748.
7. Diel R, Loddenkemper R and Nienhaus A. Evidence-Based Comparison of Commercial Interferongamma Release Assays for Detecting Active TB: A Metaanalysis. Chest; 137 (4):952-968, 2010.
8. Staras SAS, Dollard SC, Radford KW, Flanders WD, Pass RF, Cannon MJ: Seroprevalence of
cytomegalovirus infection in the United States, 1988-1994. Clin Infect Dis 2006, 43:1143-1151.
9. Rollag H, Sagedal S, Kristiansen KI et al. Cytomegalovirus DNA concentration in plasma predicts development of cytomegalovirus disease in kidney transplant recipients. Clin Microbiol Infect 2002; 8: 431–434.
10. Jakes AD, Roy A, Veerasamy M, Bhandari S. Crohn’s-like mycophenolate-induced colitis, a
fallout in steroid free regimens. Transplant Proceedings 2013, (45); 2, 842-844. Doi: 10.1016/j.
transproceed.2012.11.003
11. British Transplantation Society Guidelines for the Prevention and Management of CMV Disease after Solid Organ Transplantation. Third Edition, August 2011.
12. Stolt A, Sasnauskas K, Koskela P, et al. Seroepidemiology of the human polyomaviruses. J Gen Virol. 2003;84:1499-1504.
13. Bairy M, Sett A, Long E, Bhandari S. Obstruction or renal allograft rejection—potential clinical markers of BK virus nephropathy, Quarterly Journal of Medicine 2008: 101; (7) 594-598.
14. Beimler J, Sommerer C, Zeier M. The influence of immunosuppression on the development of BK virus nephropathy: does it matter? Nephrol Dial Transplant 2007; 22 Suppl. 8: viii66-71.
15. UK Renal Association: Post-operative Care of the Kidney Transplant Recipient. 5th Edition. 5th February 2011.
16. Fernàndez-Sabé N, Cervera C, Fariñas MC, et al. Risk factors, clinical features, and outcomes of toxoplasmosis in solid-organ transplant recipients: a matched case-control study. Clin Infect Dis 2012; 54:355.
17. First MR. Renal function as a predictor of long-term graft survival in renal transplant patients. Nephrol Dial Transplant 2003; 18 (Suppl 1): i3–i6.
18. Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. American Journal of Transplantation 2009; 9(Suppl 3):S1-S157

Disclaimers

Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.