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Case StudyOne Pediatric Patient’s Experience

Shelley Chapman RN, BSN, CCTCChildren’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

+Patient Presentation: The Next 48 Hours

+Patient Presentation Cont.

+Treatment

Recommended treatment for Adenovirus s/p BMT Cidofovir and Probenecid Side effect is

nephrotoxicity

Alternate prodrug formulation 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

+Outpatient Treatment & Follow-up

+1 Year Follow-up

+ Lessons LearnedDo not assume patient is having rejection with sudden and substantial decline in renal function

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Discussion and Questions