Ranjana Thap VBVBVCXVBVCBXVBVBVBVCBVBVBXVa.pptx
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Ranjana Thap VBVBVCXVBVCBXVBVBVBVCBVBVBXVa.pptx
- 1. RENAL PRE-TRANSPLANT MEET Dr. Manoj Aryal/ Dr. Ishwor Poudel DM Nephrology Resident/ MCh Urology Resident NAMS, Bir Hospital (2082-04-16)
- 2. DESCRIPTIONS DESCRIPTION RECIPIENT DONOR NAME Ranjana Thapa Ram Chandra Magar AGE 36 yrs. 61 yrs. SEX Female Male RELATION Daughter Father BLOOD GR/TYP A Positive O Positive ADDRESS Panchthar,Pthidim Municipality-4 Panchthar,Pthidim Municipality-13 Height 155cm 152cm Weight 56kg 69kg BMI 23.3kg/m2 29.7kg/m2
- 3. VIRAL MARKER DESCRIPTION RECIPIENT DONOR HIV I / II (2082/04/12) Non-Reactive Non-Reactive HBs Ag Non-Reactive Non-Reactive Anti HCV Non-Reactive Non-Reactive CMV IgG(2025/06/28) Positive Positive CMV IgM Negative Negative
- 4. RECIPIENT CLINICAL DETAILS PRIMARY DISEASE: CKD-CGN HD WITH CKD-MBD SINCE 4 YEARS. DIALYSIS STATUS : RIGHT IJV PERM CATH 2 MONTHS. HD EVERY (MONDAY/THRUSDAY) NO H/O BT VACCINATION:DONE
- 5. RECIPIENT INVESTIGATION HEMATOLOGY(2082/04/12) HB 11.3 TLC 9,620 DC Neutrophils 71% Lymphocytes 18% Eosinophils 07% PLT 2,14,000 PT/INR 12.7/0.84 BT 4 CT 8 aPTT 32
- 6. RECIPIENT INVESTIGATION BIOCHEMISTRY RBS(2082/04/12) 86 Total Bilirubin 0.4 FBS 97 Direct Bilirubin 0.2 HBA1C 4.9% SGPT 9 UREA 178 SGOT 26 CREATININE 9.9 ALK.PHOS 60 NA + 142 T. PROTEIN 7.6 K + 6.1 S. ALBUMIN 4.0 CALCIUM 9.8 IPTH 703.3 PHOSPHORUS 5.2 ANA Negative
- 7. RECIPIENT INVESTIGATION ANA Negative TFT(2082/04/08) FT3/FT4 4.73/1.33 TSH 2.17
- 8. RECIPIENT INVESTIGATION(2082/04/12) URINE ANALYSIS ALBUMIN 3+ SUGAR NIL RBC 1-2 WBC 2-4 CAST Nil URINE CULTURE (2082/04/12) Urine Culture Negative
- 9. RECIPIENT INVESTIGATION ECG :NSR USG: Bilateral Echogenic kidneys with loss of CMD. ECHO: (2082/02/16) LVEF 35-40%,Global LV Hypokinesia,Moderate MR, Mild TR with TRPG 17mmHg. CXR –PA: (2082/04/11): Normal Findings.
- 10. Stress ECG •Stress ECG Test Patient Exercised for 5’57’’ with workload of 7.1 METS on Bruce Protocol. Exercise terminated due to 100% THR achieved. Good effort tolerance. •No significant ST-T changes during exercise and recovery as compared to Baseline ECG.
- 11. Stress Echo •Stress Echo revealed Baseline LVEF 45% and Peak LVEF 65%.Good Contractile reserve.NO RWMA. •Test is Negative for Exercise Induced Reversible Myocardial Ischemia.
- 12. TREATMENT CARDEX S.N MEDICATION DOSE ROUTE DIRECTIONS 1 TAB MYLOD 5MG PO BD 2 3 4 6 7 8 9 TAB PANTOCID TAB METLOC-XL TAB CITRAPHOS CAP BIOD3-PLUS TAB REXTER INJ EPOFIT TAB NITROCONTIN 40MG 50MG 2TAB 1 CAP 50MG 4,000U 2.6MG PO PO PO PO PO S/C PO OD OD TDS OD BD ONCE A WEEK BD
- 13. Recipient Systemic Evaluation Clearance Chest Evaluation: Done and Cleared Cardiac Evaluation: Done and Cleared ENT Evaluation : Done and Cleared Dental Evaluation : Done and Cleared Urology: Done and Cleared PSYCHIATRY : Done and Cleared PAC : Done and Cleared CTVS : Done and Cleared OB/GYNE : Done and Cleared
- 14. DONOR EVALUATION • K/C/O Hypertension since 1 month • Taking Losartan-H OD • Taking Febuxostat For Hyperuricemia.
- 15. DONOR INVESTIGATION HEMATOLOGY(2082/04/12) HB 14.2gm% TLC 9,500 DC Neutrophils 52% Lymphocytes 39% Monocytes 02% Eosinophils 07% PLT 3,61,000 PT/INR 12.6/0.90 APTT 26.6 sec BT 1 mins CT 6 mins
- 16. DONOR INVESTIGATION BIOCHEMISTRY(2082/04/12) RBS 94 HbA1C 5.0% UREA 23 Total Bilirubin 0.3 CREATININE 0.8 Direct Bilirubin 0.1 NA + 141 SGPT 23 K + 4.17 SGOT 22 CALCIUM 9.4 ALK.PHOS 106 PHOSPHORUS 3.0 T. PROTEIN 7.1 URIC ACID 9.0 S. ALBUMIN 4.1
- 17. DONOR INVESTIGATION ANA Neg TFT(2082/02/08) FT3/FT4 3.98/0.86 TSH 2.663
- 18. DONOR INVESTIGATION(2082/04/12) URINE ANALYSIS ALBUMIN Nil SUGAR Nil RBC Nil WBC Nil CAST Nil URINE C/S(2082/04/12) NEGATIVE
- 19. DONOR INVESTIGATION ECG: NSR USG(2081/1/26) Both kidneys are normal in size Rt 9.8cm,Lt 9.6cm, outline and echotexture. CMD is maintained. ECHO(2082/01/31): LVEF:60%. CXR –PA: Grossly normal.
- 20. DONOR Systemic Evaluation Clearance Chest Evaluation: Done and Cleared Cardiac Evaluation: Done and cleared ENT Evaluation : Done and cleared Dental Evaluation : Done and Cleared UROLOGY: Done and Cleared PSYCHIATRY Done and Cleared PAC Done and Cleared CTVS Done and Cleared
- 21. DSA(28/07/2025) ANTI HLA IgG antibodies MFI Result CLASS I <500 NEGATIVE CLASS II <500 NEGATIVE CDC Cross Match Auto:- IgM NEGATIVE DTT cross match:- T & B cell cross match NEGATIVE
- 22. HLA REPORTS • Matching Ratio with Patient :08/12
- 24. THANK YOU