Question 1

The patient presented with symptoms consistent with acute kidney rejection, a severe complication of kidney transplantation. Renal transplant recipients are at risk of developing acute kidney rejection because they have immunosuppression, which is why they need to take anti-rejection drugs after their transplant (Lai et al., 2021). The patient’s nephrologist should have closely monitored him for the first few months after transplantation and adjusted his medication accordingly if necessary.

The patient also experienced an increase in weight, which is common in patients who experience rejection. If a patient has gained too much weight, he will be unable to tolerate the anti-rejection drug Cyclosporine (Neoral), which can cause toxicity and lead to death if left untreated (Lai et al., 2021). The patient had decreased urine output and increasing temperatures, both signs indicating inflammation within the body. Inflammation can become severe enough that it leads to organ damage if not treated appropriately.

The patient also presented with symptoms of acute kidney rejection because he had a cadaver donor for his kidney transplant. Although it is normal for the body to reject a new organ, this can be treated with cyclosporine and tacrolimus (Justiz Vaillant et al., 2022). However, the patient’s body could not handle the combination of these medications, and he developed rejection symptoms.

Question 2

The most likely genes to be associated with the development of acute kidney transplant rejection are the HLA genes and the B7-H1 gene. HLA genes are found on chromosome 6, called HLA-A, -B, -C, -DRB1, -DQB1, -DQA1, -DPB1, and -DQA2 (Brehm et al., 2019). They are responsible for determining what cells can be used in a transplant.

HLA-DRB1*15:01 is a significant risk factor for developing acute kidney transplant rejection in people who have received an allogeneic transplant from an HLA-DRB1*15:01 donor with graft-versus-host disease (GVHD) (Brehm et al., 2019). It has been shown that this gene is responsible for up to 10%-45% of cases of acute kidney transplant rejection after receiving an allogeneic donor. HLA-DQA1*02:01 is another risk factor for developing acute kidney transplant rejection after receiving an allogeneic donor who has had GVHD and received a graft from someone with the identical HLA-DQA1*02:01 genetic makeup (Loupy & Lefaucheur, 2018). This gene increases the likelihood of developing a graft.

The patient’s genetic makeup is most likely to be associated with the development of acute kidney transplant rejection (Lai et al., 2021). The presence of HLA-DR2 in his kidney would make him more likely to experience a stronger immune response to the transplant, which may lead to inflammation and an increase in the expression of genes that cause inflammation.

Question 3

Immunosuppression is a process by which the immune system is weakened. This can significantly affect body systems and make it more likely for an individual to get sick (McCance & Huether, 2019). The immune system is made up of white blood cells responsible for protecting the body from bacteria and viruses. These cells produce antibodies that bind to foreign invaders, such as bacteria or viruses.

Many things, including medications, infections, and cancer therapies, can cause immunosuppression. The most common causes of immunosuppression are cancer therapies (chemotherapy) and organ transplantation (McCance & Huether, 2019). Immunosuppression can also occur in people with HIV/AIDS who take antiretroviral therapy (ART), suppressing their immune system so they cannot fight off infections.

Cancer therapies and organ transplantation weaken the immune system by destroying some components or suppressing others so it can no longer fight off infections or fend off tumors (McCance & Huether, 2019). Immunosuppressive drugs are used to prevent rejection of transplanted organs and tissues after cancer surgery or after bone marrow transplants

In the case study, the patient’s immunosuppression was initially done with Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine). These drugs are known as TAC-susceptible triazines (TACS). TAC-susceptible triazines work by inhibiting a type of cell that is part of the immune system called T-cells (McCance & Huether, 2019). This prevents them from responding to transplanted organs or tissues.

Immunosuppression has several effects on the body:

• It decreases inflammation, which can help prevent organ damage or loss.
• It reduces the activity of white blood cells, which helps prevent infection and promotes healing.
• It decreases the production of substances that cause pain and fever, which helps treat pain and illness related to rejection or inflammation.

References

Brehm, M. A., Kenney, L. L., Wiles, M. V., Low, B. E., Tisch, R. M., Burzenski, L., Mueller, C., Greiner, D. L., & Shultz, L. D. (2019). Lack of acute xenogeneic graft- versus-host disease, but retention of T-cell function following engraftment of human peripheral blood mononuclear cells in NSG mice deficient in MHC class I and II expression. FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 33(3), 3137–3151. https://doi.org/10.1096/fj.201800636R

Justiz Vaillant, A. A., Vashisht, R., & Zito, P. M. (2022). Immediate Hypersensitivity Reactions. In StatPearls. StatPearls Publishing.

Lai, X., Zheng, X., Mathew, J. M., Gallon, L., Leventhal, J. R., & Zhang, Z. J. (2021). Tackling Chronic Kidney Transplant Rejection: Challenges and Promises. Frontiers in immunology, 12, 661643. https://doi.org/10.3389/fimmu.2021.661643

Loupy, A., & Lefaucheur, C. (2018). Antibody-Mediated Rejection of Solid-Organ Allografts. The New England journal of medicine, 379(12), 1150–1160. https://doi.org/10.1056/NEJMra1802677

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

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.

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.

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