Syndrome of rapid-onset end-stage renal disease in two consecutive renal transplant recipients
Patient II is a 56-year-old Caucasian hypertensive diabetic female patient, with SPK from 1991 for ESRD and was maintained on chronic transplant immunosuppression with cyclosporine and prednisone. During the first quarter of 2010, allograft CKD stage III was stable; serum creatinine was 1.8 mg/dL in April 2010. She suffered from pneumonia and congestive heart failure (CHF) exacerbation that same month, complicated by AKI and a transient but reversible rise in serum creatinine. This illness was then subsequently followed by vomiting from symptomatic diabetic gastroparesis, together with dehydration, and this time serum creatinine rose further to about 3.4 mg/dL the following month, in May 2010. Her renal allograft function again improved and serum creatinine had returned to 1.8 mg/dLdl, her previous baseline, as at of June 14, 2010. She then experienced two back-to-back episodes of AKI associated with pneumonia in July 2010, and this time serum creatinine rose quickly to 4.8 mg/dL, further complicated by oliguria and volume overload, and her renal allograft function has remained irreversibly damaged. Through July 2012, 24 months later, she has since remained on maintenance hemodialysis for irreversible ESRD. Also, remarkably, her pancreas allograft has however remained functional with a current normal HbA1c of 4.7%.