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Case Study One Pediatric Patient’s Experience. Shelley Chapman RN, BSN, CCTC Children’s Hospital of Wisconsin. Patient History. 15 year old Caucasian male Past medical history L iver transplant 3 year old Fulminant liver failure of unknown etiology Bone marrow transplant 12 years old
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Case StudyOne Pediatric Patient’s Experience Shelley Chapman RN, BSN, CCTC Children’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
Treatment • Recommended treatment for Adenovirus s/p BMT • Cidofovir and Probenecid • Side effect is nephrotoxicity • Alternate prodrugformulation 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
Lessons Learned Do not assume patient is having rejection with sudden and substantial decline in renal function