33 yo M with a kidney transplant

OBJECTIVES:

  • Emergency management of hyperkalemia
  • Evaluate AKI in a patient with a kidney transplant
  • Recognize transplant related drug toxicities

CASE:

A 33 yo M presents with numbness/tingling and pain in his feet. He underwent a deceased donor renal transplant 6 months ago with his post transplant course complicated by severe necrotizing pancreatitis status post intraabdominal drain placement and acute renal failure secondary to BK nephropathy. Over the past 4 days, he’s had increasing numbness/tingling and pain in his bilateral toes/feet. The distribution is in a “sock-like” distribution and he has no associated weakness. He has also noted increased tremors in his hands/feet as well. He otherwise has felt in his usual state of health.

On exam, he had normal VS. He was generally well appearing and was in no distress. His skin exam was notable for mild erythema and swelling over 1st MTP but no significant tenderness to palpation and near full ROM. Neurologic exam revealed decreased sensation over his toes bilaterally.

He presented to the ED and had stable vital signs. His initial labs were notable for a Cr of 3.4 (baseline of 1.5) and K of 6.9.

What would you do now? Skip this section for higher level learners or to save time. 


CASE CONTINUED:

What is your differential diagnosis? 

What work up would you want?


FINAL DIAGNOSIS AND OUTCOME:

TAKE HOME POINTS:


REFERENCES:

  1. Goldberg, RJ, Weng, FL, & Kandula, P. 2016. Acute and Chronic Allograft Dysfunction in Kidney Transplant Recipients. Medical Clinics of North America. 100 (3):487-503
  2. Jantz, AS, et al. 2013. Treatment of Acute Tacrolimus Toxicity with Phenytoin in Solid Organ Transplant Recipients. Case Reports in Transplantion.