Transplanted
Renal & Urinary System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S10_F1.jpg"}},{"insert":"\n\n"},{"insert":"It is the day following the World Kidney Day, and you can finally relax after several busy weeks of organizing and executing awareness campaigns.\n\nYou are barely done reading the (mostly) positive feedback on your speech on \u0022Kidney Health for All\u0022, when the first patient of the day walks in.\n\n\u0022Back to my regular routine\u0022, you contentedly think, as you put down your tablet and greet him.\n"}]}
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{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S10_F2.jpg"}},{"insert":"\n\n"},{"insert":"Michael Chen is a 60 year-old Chinese immigrant. \r\n\r\nA frequent visitor to your office, he developed so-called \u0022chronic nephritis\u0022 when he was young, and subsequently ended up with end-stage renal disease, which has required hemodialysis for the last 3 years.\n\nCurrently, he undergoes hemodialysis thrice a week, with each cycle lasting 4 hours.\r\n\r\nDuring the last cycle, his serum creatinine before and after dialysis was 830 \u00b5mol\/L (9.4 mg\/dL) and 445 \u00b5mol\/L (5.0 mg\/dL) respectively.\n\nHe was also mildly anemic with an Hb of 10.5 g\/dL, which is being treated with 36000 IUS of recombinant erythropoietin (rhEPO) per week.\n\nAccording to his medical records, he also has a longstanding history of hypertension and obstructive sleep apnea. \r\n\r\nHe has not undergone any surgeries, or been transfused with blood in the past.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S10_F3.jpg"}},{"insert":"\n\n"},{"insert":"You notice that Mr. Chen seems somewhat depressed today.\r\n\r\n\u0022Doctor, I\u0027m fed up with hemodialysis! I don\u0027t have any freedom! Is there any other option? Could I apply for kidney transplantation?\u0022\n"}]}
3
{"ops":[{"insert":"How do you respond?\n"}]}
1. "Well, since you have been on hemodialysis for only 3 years, let's not rush into transplantation yet."
2. "Given your age and your medical records, I think renal transplantation is a bit too risky right now."
3. "Yes, I guess we can consider it, but let's run a couple of tests first."
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