Case Study Analysis Paper

Case Study Analysis Paper

 

Module 1 Assignment: Case Study Analysis

Body functioning at the cellular level is influenced by genetic, environmental, and molecular among other factors. My assigned case for this week’s discussion is about a 38-year-old Hispanic American male who had a kidney transplant from cadaveric donation following end-stage renal disease (ESRD). He is then discharged on Azathioprine, cyclosporine, and tacrolimus to prevent rejection. However, after six months, he presented with weight gain, fatigue, fever, and decreased urine output. The purpose of this discussion is to explain the pathophysiology of this patient’s presentation, the genetic basis of his disease, and the process of immunosuppression.

Pathophysiology

Weight gain, decreased urine output, fatigue, and fever are suggestive of acute kidney injury. However, other differentials such as acute transplant rejection, drug toxicity, vascular thrombosis, and thrombotic microangiopathy (Dudreuilh et al., 2018). On the readmission, the patient was diagnosed by his nephrologist with acute transplant rejection. Acute transplant rejection is mediated by cell-mediated immunity, where host immune cells attack the allograft. In this case, the host immune cells attacked the new kidney (McCance & Huether, 2019). Unfortunately, that was the only functioning kidney he had, he developed acute kidney injury. In acute kidney injury, waste and water excretion become limited with limited kidney function. Water retention leads to weight gain and reduced urine output. Retention of wastes such as urea led to uremia that presented as fatigue.

According to Dudreuilh et al. (2018), septic acute kidney injury is common in patients with acute kidney transplant rejection. This explains the cause of the patient’s fever. The immunosuppressive medications were responsible for the reduction in immune system function and opened the way for opportunistic infections. Therefore, acute kidney due to or in conjunction with the medications, immunologic reactions, and bacterial infections could be responsible for the patient’s symptoms.

Genetic Basis

The patient is of Hispanic descent and presented at first with end-stage renal disease. ESRD is common among Hispanics and is usually associated with diabetes mellitus among this population (Desai et al., 2019). In this patient, acute kidney transplant rejection would result from various genes. Reynolds (2019), through the National Institute of Health (NIH) research matters, raised concern about gene deletion that involved a gene called LIMS1 that could be responsible for kidney transplant rejection among patients and presented a higher risk – about 80%. However, a recent study by Bogacz et al. (2021) established that the impact of polymorphisms in TGFB1 and CTLA4 genes were not responsible for the rejection of kidney transplants. Kang et al. (2021) found out that rejection could be a result of HLA-G 14-bp insertion/deletion polymorphism in some individuals, especially among Asians.

Immunosuppression

Immunosuppression reduces the body’s capacity to react to foreign antigens, objects, or organs. Immunosuppression enhances the proliferation of fibroblasts and the synthesis of matrix elements. Therefore, it subverts the surveillance by innate and adaptive immunity against these foreign organs and organisms (Huaux, 2018). Some medications suppress the bone marrow’s ability to make new cells to help in the immunologic fight. This negatively impacts other systems that rely on these cells and the mediators they produce. The hematologic system is rendered weak, and resistant anemia would lead to hypoperfusion of end organs.

Conclusion

The patient developed acute rejection and presented with features of septic acute kidney injury as a result of water and waste retentions with possible superimposed infection. Acute kidney due to or in conjunction with the medications, immunologic reactions, and bacterial infections could be responsible for his symptoms. LIMS1 deletion and HLA-G 14-bp insertion/deletion polymorphism could have increased his susceptibility to his rejection. The immunosuppressive medications used limited his innate and adaptive defense systems leading to reduced cell prediction and possible anemia.

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References

Bogacz, A., Wolek, M., Sieńko, J., Czerny, B., Machaliński, B., Olbromski, P., & Kotowski, M. (2021). Influence of TGFB1 and CTLA4 polymorphisms on calcineurin inhibitors dose and risk of acute rejection in renal transplantation. Scientific Reports, 11(1), 17531. https://doi.org/10.1038/s41598-021-96457-7

Desai, N., Lora, C. M., Lash, J. P., & Ricardo, A. C. (2019). CKD and ESRD in US Hispanics. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 73(1), 102–111. https://doi.org/10.1053/j.ajkd.2018.02.354

Dudreuilh, C., Aguiar, R., & Ostermann, M. (2018). Acute kidney injury in kidney transplant patients. Acute Medicine, 17(1), 31–35. https://pubmed.ncbi.nlm.nih.gov/29589603/

Huaux, F. (2018). The emerging role of immunosuppression in diseases induced by micro-and nano-particles: Time to revisit the exclusive inflammatory scenario. Frontiers in Immunology, 9, 2364. https://doi.org/10.3389/fimmu.2018.02364

Kang, S. W., Oh, E., Cho, W., Kim, M., Park, E. J., Kwack, K. H., Chung, K., Nam, O. H., Chae, Y. K., & Ban, J. Y. (2021). HLA-G 14bp Ins/Del polymorphism in the 3′UTR region and acute rejection in kidney transplant recipients: An updated meta-analysis. Medicine (Kaunas, Lithuania), 57(10), 1007. https://doi.org/10.3390/medicina57101007

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Mosby.

Reynolds, S. (2019). Gene deletion raises the risk of kidney transplant rejection. NIH Research Matters. https://www.nih.gov/news-events/nih-research-matters/gene-deletion-raises-risk-kidney-transplant-rejection

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier in the references.

Learning Resources
Required Readings (click to expand/reduce)

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Chapter 1: Cellular Biology; Summary Review
Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents(pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases,
Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
Chapter 7: Innate Immunity: Inflammation and Wound Healing
Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
Chapter 10: Infection (stop at Infectious parasites and protozoans); (start at HIV); Summary Review
Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review
Note: You previously read these chapters in Week 1 and you are encouraged to review once again for this week.

Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/

​Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls.

Note: This article was presented in the Week 1 resources. If you read it previously you are encouraged to review it this week.

Required Media (click to expand/reduce)

Foundational Concepts of Cellular Pathophysiology – Week 2 (8m)

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Accessible player
Walden University. (n.d.). Instructor feedback. https://cdn-media.waldenu.edu/2dett4d/Walden/WWOW/1001/pulse_check/instructor_feedback/index.html#/

Immunity and Inflammation
Khan Academy (2010, February 24). Inflammatory response | Human anatomy and physiology | Health & medicine [Video file]. Retrieved from https://www.youtube.com/watch?v=FXSuEIMrPQk

Note: The approximate length of the media program is 14 minutes.

Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file]. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds

Note: The approximate length of the media program is 37 minutes.

Acid-Base Balance #1
MedCram. (2012, April 28). Medical acid base balance, disorders & ABGs explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=4wMEMhvrQxE

Note: The approximate length of the media program is 13 minutes.

Acid-Base Balance #2
MedCram. (2012, April 29). Medical acid base balance, disorders & ABGs explained clearly | 2 of 8 [Video file]. Retrieved from https://www.youtube.com/watch?v=GmEeKVTpOKI

Note: The approximate length of the media program is 15 minutes.

Hyponatremia
MedCram. (2017, December 23). Hyponatremia explained clearly [LK1] (remastered) – Electrolyte imbalances [Video file]. Retrieved from https://www.youtube.com/watch?v=bLajK5Vy55M

Note: The approximate length of the media program is 15 minutes.

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.

Photo Credit: Getty Images/Hero Images

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.

Scenario 3:
A 34-year-old Hispanic-American male with end-stage renal disease received kidney transplant from a cadaver donor, as no one in his family was a good match. His post-operative 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 101ËšF. He was evaluated by his nephrologist, who diagnosed acute kidney transplant rejection.

The Assignment (1- to 2-page case study analysis)
Develop a 1- to 2-page case study analysis in which you:

1. Explain why you think the patient presented the symptoms described.
2. Identify the genes that may be associated with the development of the disease.
3. Explain the process of immunosuppression and the effect it has on body systems.

NOTE;
PLEASE INCLUDE AN INTRODUCTION WITH A PURPOSE STATEMENT, TITLE PAGE, REFERENCE PAGE, AND A SUMMARY