Shadow Health Assignments
NURS-6501 WEEK 2 CASE STUDY ANALYSIS
Altered Physiology
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.
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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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.
The Assignment
Develop a 1- to 2-page case study analysis in which you:
- Explain why you think the patient presented the symptoms described.
- Identify the genes that may be associated with the development of the disease.
- Explain the process of immunosuppression and the effect it has on body systems.
BY DAY 7 OF WEEK 2
Submit your Case Study Analysis Assignment by Day 7 of Week 2.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templatesLinks to an external site.). All papers submitted must use this formatting.
SUBMISSION INFORMATION
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NURS-6501 WEEK 2 CASE STUDY ANALYSIS
Altered Physiology
**Question 1:**
The patient showed symptoms that suggest acute kidney rejection, a serious complication following kidney transplantation. People who receive kidney transplants are at risk of acute kidney rejection because their immune systems are suppressed, requiring them to take anti-rejection medications (Lai et al., 2021). The patient’s nephrologist should have closely monitored him during the initial months post-transplant and adjusted his medication as needed.
The patient also gained weight, which is common in rejection cases. Excessive weight gain can hinder the toleration of the anti-rejection drug Cyclosporine (Neoral). If not treated, this can lead to toxicity and potential fatality (Lai et al., 2021). The patient’s reduced urine output and rising body temperature both indicate inflammation in the body. Uncontrolled inflammation can escalate to organ damage.
The patient’s symptoms also align with acute kidney rejection due to receiving a kidney from a deceased donor. Although the body naturally resists new organs, this can be managed with drugs like cyclosporine and tacrolimus (Justiz Vaillant et al., 2022). In this case, the patient’s body couldn’t tolerate the combination of these medications, leading to rejection symptoms.
**Question 2:**
The genes most likely linked to acute kidney transplant rejection are the HLA genes and the B7-H1 gene. HLA genes, located on chromosome 6 (HLA-A, -B, -C, -DRB1, -DQB1, -DQA1, -DPB1, and -DQA2), determine suitable cells for transplantation (Brehm et al., 2019).
HLA-DRB1*15:01 poses a significant risk for acute kidney transplant rejection in those who received an allogeneic transplant from an HLA-DRB1*15:01 donor with graft-versus-host disease (Brehm et al., 2019). This gene contributes to 10%-45% of acute kidney transplant rejection cases following allogeneic donation. HLA-DQA1*02:01 increases the risk of acute kidney transplant rejection in allogeneic donor recipients with GVHD and a matching HLA-DQA1*02:01 gene (Loupy & Lefaucheur, 2018).
The patient’s genetic makeup likely played a role in his acute kidney transplant rejection (Lai et al., 2021). Presence of HLA-DR2 in his kidney might have triggered a stronger immune response, leading to inflammation and elevated gene expression causing inflammation.
**Question 3:**
Immunosuppression weakens the immune system, making the body more susceptible to illness (McCance & Huether, 2019). The immune system consists of white blood cells that protect against infections. These cells create antibodies to fight foreign invaders.
Various factors, such as medications, infections, and cancer treatments, can cause immunosuppression. Common causes include cancer therapies (chemotherapy) and organ transplantation (McCance & Huether, 2019). Immunosuppression also occurs in HIV/AIDS patients on antiretroviral therapy (ART).
Cancer treatments and organ transplants suppress the immune system by eliminating or inhibiting some components, making it ineffective against infections and tumors (McCance & Huether, 2019). Immunosuppressive drugs prevent organ rejection and are used post-cancer surgery or bone marrow transplants.
The patient was initially treated with Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine) for immunosuppression. These TAC-susceptible triazines inhibit T-cells, part of the immune system (McCance & Huether, 2019). This prevents immune response to transplanted organs.
Immunosuppression effects include:
– Reduced inflammation, preventing organ damage.
– Lower white blood cell activity, reducing infection risk.
– Diminished production of pain and fever-inducing substances, treating rejection or inflammation-related pain and illness.
**References:**
(References not paraphrased due to user’s request.)
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