G.P. is a 52-year-old, 72-kg African American man with end-stage renal disease (ESRD) secondary to non–insulin-dependent diabetes mellitus, hypertension, and hyperlipidemia. He has been undergoing hemodialysis three times a week for 4 years. Other medical problems include anemia, hypocalcemia, and hyperphosphatemia. G.P.’s medications include amlodipine 10 mg daily, ramipril 10 mg twice daily (BID), Lipitor 20 mg daily, Tums two tablets with meals and at bedtime, sevelamer 800 mg with meals, NPH insulin 30 international units BID, regular insulin 8 international units BID, and erythropoietin 8,000 international units IV three times weekly. He has been on the kidney transplant waiting list for 2 years. He is called by the transplant coordinator and admitted for a possible deceased donor (formerly called cadaveric) kidney transplant. G.P. has the same blood type as the donor. His most recent PRA is 10%. Cross-match is negative, and HLA typing reveals a three-antigen match (A1, A2, B35) between donor and recipient. On admission to the hospital, his laboratory values are as follows: Na, 141 mEq/L Potassium (K), 4.7 mEq/L Cl, 102 mEq/L Bicarbonate (HCO3), 23 mEq/L Blood urea nitrogen (BUN), 44 mg/dL Serum creatinine (SCr), 13.9 mg/dL Calcium (Ca), 7.8 mEq/L Phosphorus, 6.2 mg/dL Glucose, 225 mg/dL WBC count, 8.4 cells/?L Hemoglobin (Hgb), 10.8 g/dL Hematocrit (Hct), 32% His serology is negative for HIV, hepatitis B surface antigen (HbsAg), hepatitis C, and cytomegalovirus (CMV), and is positive for antibody to the surface antigen of hepatitis B (anti-Hbs). What are the indications for and potential benefits of kidney transplantation in G.P.?
G.P. is a 52-year-old, 72-kg African American man with end-stage renal disease (ESRD) secondary to non–insulin-dependent diabetes mellitus, hypertension, and hyperlipidemia. He has been undergoing hemodialysis three times a week for 4 years. Other medical problems include anemia, hypocalcemia, and hyperphosphatemia. G.P.’s medications include amlodipine 10 mg daily, ramipril 10 mg twice daily (BID), Lipitor 20 mg daily, Tums two tablets with meals and at bedtime, sevelamer 800 mg with meals, NPH insulin 30 international units BID, regular insulin 8 international units BID, and erythropoietin 8,000 international units IV three times weekly. He has been on the kidney transplant waiting list for 2 years. He is called by the transplant coordinator and admitted for a possible deceased donor (formerly called cadaveric) kidney transplant. G.P. has the same blood type as the donor. His most recent PRA is 10%. Cross-match is negative, and HLA typing reveals a three-antigen match (A1, A2, B35) between donor and recipient. On admission to the hospital, his laboratory values are as follows: Na, 141 mEq/L Potassium (K), 4.7 mEq/L Cl, 102 mEq/L Bicarbonate (HCO3), 23 mEq/L Blood urea nitrogen (BUN), 44 mg/dL Serum creatinine (SCr), 13.9 mg/dL Calcium (Ca), 7.8 mEq/L Phosphorus, 6.2 mg/dL Glucose, 225 mg/dL WBC count, 8.4 cells/?L Hemoglobin (Hgb), 10.8 g/dL Hematocrit (Hct), 32% His serology is negative for HIV, hepatitis B surface antigen (HbsAg), hepatitis C, and cytomegalovirus (CMV), and is positive for antibody to the surface antigen of hepatitis B (anti-Hbs). What are the indications for and potential benefits of kidney transplantation in G.P.?
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G.P. is a 52-year-old, 72-kg African American man with end-stage renal disease (ESRD) secondary to non–insulin-dependent diabetes mellitus, hypertension, and hyperlipidemia. He has been undergoing hemodialysis three times a week for 4 years. Other medical problems include anemia, hypocalcemia, and hyperphosphatemia. G.P.’s medications include amlodipine 10 mg daily, ramipril 10 mg twice daily (BID), Lipitor 20 mg daily, Tums two tablets with meals and at bedtime, sevelamer 800 mg with meals, NPH insulin 30 international units BID, regular insulin 8 international units BID, and erythropoietin 8,000 international units IV three times weekly. He has been on the kidney transplant waiting list for 2 years. He is called by the transplant coordinator and admitted for a possible deceased donor (formerly called cadaveric) kidney transplant. G.P. has the same blood type as the donor. His most recent PRA is 10%. Cross-match is negative, and HLA typing reveals a three-antigen match (A1, A2, B35) between donor and recipient. On admission to the hospital, his laboratory values are as follows: Na, 141 mEq/L Potassium (K), 4.7 mEq/L Cl, 102 mEq/L Bicarbonate (HCO3), 23 mEq/L Blood urea nitrogen (BUN), 44 mg/dL Serum creatinine (SCr), 13.9 mg/dL Calcium (Ca), 7.8 mEq/L Phosphorus, 6.2 mg/dL Glucose, 225 mg/dL WBC count, 8.4 cells/?L Hemoglobin (Hgb), 10.8 g/dL Hematocrit (Hct), 32% His serology is negative for HIV, hepatitis B surface antigen (HbsAg), hepatitis C, and cytomegalovirus (CMV), and is positive for antibody to the surface antigen of hepatitis B (anti-Hbs). What are the indications for and potential benefits of kidney transplantation in G.P.?
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