Téma:  Case Studies

Quality of life improvement and successful delivery after kidney transplantation

Jaroslav Rosenberger, Tatiana Baltesová, Mária Majerníková, Monika Michrinová

Kidney transplantation is the method of choice in treatment of end-stage renal disease due to longer survival, lower morbidity and costs and improved quality of life. 22-year old female developed rapid proggressive glomerulonephritis due to ANCA positive necrotising vasculitis in her 11 years and shortly became anuric and dialysis dependant. She started long-term hemodialysis program in 1998; kidney transplantation in 1999 was unsuccessful due to renal vein thrombosis. She had several relapses of vasculitis during next years manifesting mainly in respiratory and joint systems and she was treated by corticosteroids, cyclophosphamid and plasmapheresis. 16. 3. 2007 she underwent kidney transplantation from a deceased donor. Daclizumab, corticosteroids, mycophenolate mofetil a tacrolimus were used as the immunosuppression regime. Postransplant period was uneventful, and patient’s status significantly improved. Aneurysmatic fistula on her arm with negative effect on heart function could be ligated after 3 months. Patient desired pregnancy one year after transplantation, so her immunosuppression treatment was changed (prednisone, tacrolimus, azathioprin) and subsequently she became pregnant. Gravidity was complicated with herpes zoster which required acyclovir treatment and with antibody positivity against toxoplasmosis. Due to signs of gestosis gravidity was terminated in 36. gestation week by Cesarean section (healthy boy 2010 g, 46 cm). Patient developed acute pyelonephritis of transplanted kidney with acute kidney injury, but because of noncompliance she was treated only conservatively. At the present time patient feels well, serum creatinine is approximately 120 μmol/l. Her child suffered from repeated respiratory infections. Successful delivery is a rare event amongst dialysis patients, and even after kidney transplantation it is uncommon. Management of pregnant kidney transplant recipient is complicated and requires a complex care including adjustments in immunosuppression therapy and co-operation between different medical experts.

Ročník 2009  Témy časopisu Internal medicine 7 / 2009

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prof. MUDr. Ivica Lazúrová, CSc. FRCP

REPRESENTATIVE OF CHAIRMAN
prof. MUDr. Juraj Payer, CSc., FRCP

MEMBERS OF THE EDITORIAL BOARD
doc. MUDr. Viera Fábryová, CSc.
MUDr. Viera Fedelešová, CSc.
prof. MUDr Martin Haluzík, CSc.
prof. MUDr. Štefan Hrušovský, CSc. Dr.SVS.
prof. MUDr. Rudolf Hyrdel, CSc.
doc. MUDr. Oľga Jurkovičová, CSc.
doc. MUDr. Zdenko Killinger, PhD.
doc. MUDr. Soňa Kiňová, PhD.
prof. MUDr. Peter Mitro, PhD.
doc. MUDr. Viliam Mojto, CSc., MHA
prof. MUDr. Karel Pacák, DrSc.
prof. MUDr. Juraj Payer, CSc., FRCP
doc. MUDr. Ján Podoba, CSc.
prof. MUDr. Igor Riečanský, DrSc.
doc. MUDr. Ján Staško, PhD.
doc. MUDr. Mária Szántová, PhD.
prof. MUDr. Ivan Tkáč, PhD.

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2. Stenestrand U, Wallentin L. Swedish Register of Cardiac Intensive Care (RIKS-HIA): Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 2001; 285(4): 430-436.
3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
4. Jurkovičová O, Spitzerová H, Cagáň S. Komorové arytmie a náhla srdcová smrť pri akútnom infarkte myokardu. Bratisl Lek Listy 1997; 98: 379-389.
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