Brian - Kidney Transplant

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Background

Concise Summary

Brian is in his 40s and was well until age 23 when he was involved in a motorcycle accident. He had a number of internal complications and ended up with a left nephrectomy and thrombosed right renal artery. Despite an attempt to re-establish the circulation through the renal artery, the patient continued to be oliguric and was started on dialysis.

Brian was on hemodialysis from 1984 until 1986, and was about to be switched to peritoneal dialysis when his first kidney transplant was performed on May 8, 1986. Two years later, his kidney transplant failed and the patient was back on hemodialysis. A few months later, he received a second kidney transplant from his brother. This kidney may have been damaged by a biopsy procedure and worked for only one year. Since 1989 the patient has been on dialysis, In-Centre initially then at home and more recently, he was switched to home nocturnal hemodialysis, five nights out of seven (he skips Wednesday and Saturday).

Brian feels very well on nocturnal dialysis. He is able to carry out most household activities and some sports including golf and hockey. He is unable to work, however, and remains on disability. He regrets being unable to pursue a career. He is able to eat normally and takes a cholesterol-lowering drug. He consumes alcohol modestly (3-4 beers per month) and has smoked cigarettes for 10 years (10/day).

He has had a number of complications related to chronic hemodialysis

Details from session

  • 43 year old man
  • Worked for petrocan after his accident and before his first kidney failed
  • Had transplant 19 months after accident
  • When Brian rejected his first kidney, he felt
    • like he had a sudden, heavy flu
    • very nautious
  • His first kidney's rejection had a very sudden onset
  • Cadaveric donation (not live)
  • Family was being tested for match
  • cadaveric donor came up before testing was complete
  • Put on OKT3 to try to save the kidney ("turn it around")
    • Stopped his heart, but didn't save the kidney
  • On dialysis pending second kidney
  • Brother finally gave him his second kidney
  • Second kidney was lost 7 months later
  • Brother's wife was worried about him donating his kidney
    • Always worry or complication about any surgery
    • Brother had two children at home
  • No rejection in the second kidney
  • Had an abscess, so was in hospital
  • Was getting liquid cyclosporin and demerol
  • Doing biopsy, and damaged kidney
  • Lost kidney
  • Feels that it was bad luck "What can you do about it?"
  • Doctor initially told him it was rejection
  • Didn't feel it was a problem that the doctors lied
  • Thinks it was more likely miscommunication
  • Dialysis is part of his routine now
  • 23 year old when his accident happened
  • Just finished university
  • Feels he had a good support system
  • Met his wife when he was sick
  • The day he finished training to do self-exchanges in peritoneal dialysis was the day he got the call for a transplant
  • Would take nocturnal dialysis over transplant at this stage
  • had lots of support
    • e.g., kidney foundation; social workers
    • Didn't like talking about things "like that" with social workers
    • "Couldn't imagine having to go through this by myself, especially at the start"
  • Worked for the kidney foundation to setup the peer-support chapter in London
  • Personally doesn't like dealing with social workers, but worked with them professionally
  • Nurses are a great support, especially because a lot of time is spent around them
  • Very healthy before accident
    • No allergies, no medications
  • No health problems that are not dialysis-related
  • Current side effects are: anemic, tired
  • "just don't feel good" when on conventional dialysis
  • Urea is high, so you want to drink
  • Night dialysis is more constant, and thus more gentle
  • Couldn't eat meat or protein
  • Left kidney foundation 4 years ago
  • unemployed currently
  • After accident, worked for petro can as a salesman, then lost the first transplant
  • Opened up a printing business, but had to close it up after second transplant
  • Not presently looking for work
  • Disability plans through government and kidney foundation
  • Enjoys golf, weight lifting
  • Can't consume alcohol (4 beers in a month)
  • Smokes <10 cigarettes a day
  • Kid is unaffected generally by the dialysis
    • Takes friends to see machine
  • Checkup every three months
  • Current medications: Urethropoietin, multivitamin, lipitor
  • Surgery to put in catheter for peritoneal, fistula

Possible objectives

  • What dietary restrictions and lifestyle modifications do patients with renal failure have to make?
  • If one kidney ruptures, what happens to the other? Does physical activity/inactivity affect the outcome?
  • what are the side effects of demerol? How does demerol affect anti-rejection drugs
  • Discuss dialysis in general
  • Discuss the methods, cost, and impact on patients with regards to "conventional", peritoneal, hemodialysis, and nocturnal dialysis. What are the pros and cons of each (both from a physician and patient perspective)?
  • What is the extent of OHIP coverage?
  • How do kidneys fail in general? How could Brian's motorcycle accident have caused kidney failure?
  • What are the issues associated with medical error within the hospital as well as between the patient and physician. Discuss this in terms of the doctor-doctor relationship, doctor-patient relationship, and doctor-public relationship.
  • How would the transplant process differ between receiving from a cadaveric donor vs. a family member?
  • What is the kidney foundation? How are they funded? What services do they offer? How do patients access these services?

Resources