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+ Case Study One Pediatric Patient’s Experience Shelley Chapman RN, BSN, CCTC Children’s Hospital of Wisconsin
+
Case StudyOne Pediatric Patient’s Experience
Shelley Chapman RN, BSN, CCTCChildren’s Hospital of Wisconsin
+Patient History
15 year old Caucasian male
Past medical history Liver transplant
3 year old Fulminant liver failure
of unknown etiology Bone marrow transplant
12 years old Aplastic anemia
Kidney transplant 13 years old Immunosuppression
+Patient Presentation
Presented to the Renal Clinic 5 day history of dysuria 2 day history of gross hematuria
Labs Creatinine elevated at
1.49mg/dl Increased from his baseline of
0.8mg/dl
Hospital admission Further evaluation and
presumed rejection Renal ultrasound was done to
evaluate for stones IV fluids on the day of admission
+Patient Presentation: The Next 48 Hours
+Patient Presentation Cont.
+Treatment
Recommended treatment for Adenovirus s/p BMT Cidofovir and Probenecid Side effect is
nephrotoxicity
Alternate prodrug formulation of Cidofovir (CMX001) recommended Drug currently in clinical
trials
+Treatment Continued
The Adenovirus PCR peaked at 137,000 copies Slowly improved
Experienced intermittent fevers without bacteremia
Immunosuppression changes DC Mycophenolate Mofetil Continued on Tacrolimus
and Prednisone
Patient discharged to home after 10 days
+Outpatient Treatment & Follow-up
+1 Year Follow-up
+ Lessons LearnedDo not assume patient is having rejection with sudden and substantial decline in renal function
+
Discussion and Questions
