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Case Study One Pediatric Patient’s Experience

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 Study One Pediatric Patient’s Experience

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  1. Case StudyOne Pediatric Patient’s Experience Shelley Chapman RN, BSN, CCTC Children’s Hospital of Wisconsin

  2. 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

  3. 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

  4. Patient Presentation: The Next 48 Hours

  5. Patient Presentation Cont.

  6. 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

  7. 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

  8. Outpatient Treatment & Follow-up

  9. 1 Year Follow-up

  10. Lessons Learned Do not assume patient is having rejection with sudden and substantial decline in renal function

  11. Discussion and Questions

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