Transplant Quiz
Answer to Transplant Quiz 11/26/11: The correct answer is acute tubular injury. The differential diagnosis is provided below:
- Pre-renal state (bleeding, hypovolemia)
- Clotted Foley catheter
- Vascular complications
- Renal arterial or venous thrombosis
- Ureteric leak/obstruction
- Hyperacute rejection
- Acute tubular injury
- Thrombotic microangiopathy
____________
A 54 year old male with past history of allogeneic stem cell transplant for acute lymphocytic leukemia. He developed ESRD post stem cell transplant from thrombotic microangiopathy (TMA). He was on tacrolimus and steroid at the time of renal failure. The exact etiology of TMA was not clear. Native urine output is about a liter/day. He underwent living unrelated renal transplant with simulect induction and FK, MMF and steroid maintenance. The donor was a 63 year old gentleman with hypertension (controlled on one medication). The recipient’s pre transplant BP is 90/50 mmHg. Peri-transplant, recipient’s systolic BP dropped frequently to 80’s in spite of multiple boluses of IV fluids. Post op day 1, the patient made 30cc/hour of blood stained urine. Creatinine remained unchanged at 6.4 mg/dL. What is the differential diagnosis and next steps?
(case and slides below provided by Anand Vadivel, MD and Sayeed Malek, MD, Brigham and Women’s Hospital, Boston, MA)
 |
| Table 1 |
 |
| Table 2 |
 |
| Table 3 |
