Critical Review of a Clinical Scenario on Diabetic Control and Kidney Transplantation

The assignment is a critical review of a set clinical scenario (4000 words written assignment). Please see the attached file .

The assignment is a critical review of a set clinical scenario (4000 words written assignment– 70% of the module mark)

History

A-42-year-old CKD 5 patient due to diabetic nephropathy (biopsy-proven) presented to you in the transplant clinic for transplant assessment. She is not yet on dialysis and her current eGFR is 20 mls/mins. She was diagnosed at the age 29 to have DM. It is not clear from notes whether she is type 1 or type II DM. She is currently on insulin with frequent admissions due to ketoacidosis, especially during the last 2 years. She drinks alcohol regularly and she is a heavy smoker (20 cigarettes/day for the last 18 years). Her kidney function started to deteriorate 4 years after the diagnosis of DM. She has heavy proteinuria (7g/day) and hypoalbuminemia (serum albumin is 18mg/L). Her plain X-Ray pelvis of vascular calcification is shown below. She has no DSA and her 32-year-old sister whose blood pressure is well controlled by 3 agents (calcium channel blockers, beta-blocker and angiotensin receptors antagonist), but no other available information) expressed her interest to donate a kidney for her.

1. The assignment is a critical review of a set clinical scenario (4000 words written assignment– 70% of the module mark)

Please discuss the possible options of diabetic control and the outcome of each option addressing graft(s) survival, patient survival, and postoperative complications!

Briefly (not more than 1000 words) outline the workup of this prospective recipient!

Council the potential donor regarding kidney donation and briefly discuss the suitability of this potential donor!

Assume that this donor is normotensive and NOT on any medications, but has 2+ of blood on the dipstick, but no proteinuria. How do you proceed?

Discuss the effect of smoking and alcohol consumption on the outcome of transplantation

The above points in the task must be covered to pass .

Number of references at least :  20