In this Assignment you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis

Module 1 Assignment: Case Study Analysis

An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.

Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.

The Assignment (1- to 2-page case study analysis)

Develop a 1- to 2-page case study analysis in which you:

• Explain why you think the patient presented the symptoms described.
• Identify the genes that may be associated with the development of the disease.
• Explain the process of immunosuppression and the effect it has on body systems.

Scenario 3: A 34-year-old Hispanic-American male with end-stage renal disease received a kidney transplant from a cadaver donor, as no one in his family was a good match. His post-operative course was uneventful, and he was discharged with the antirejection drugs Tacrolimus (Prograf), Cyclosporine (Neoral), and Imuran (Azathioprine).

He did well for 3 months and had returned to his job as a policeman. Six months after his transplant, he began to gain weight, had decreased urine output, was very fatigued, and began to run temperatures up to 101?F. He was evaluated by his nephrologist, who diagnosed acute kidney transplant rejection.

Expert Answer and Explanation

Altered Physiology and Kidney rejection

Certain medical conditions including the kidney disease can alter one’s functional changes, and the alteration of these changes can have an adverse impact on the wellbeing of the patient. This altered physiology is noticeable, for example, in a patient who receives kidney transplant, and it manifests as an antirejection condition which requires clinical intervention.

There are various factors that cause one’s body to reject a donor organ, and while the medication can be effective in managing this rejection, the efficacy of the medication for the patient may reduce (Procópio et al., 2014). Immunosuppression, as a process, is a contributory factor to the rejection, and it is important to explore the reason for the presenting symptoms, and examine this process and the impact it has on the body system.

Reason for the Presenting Symptoms

Based on the scenario, the patient presents a number of symptoms which occur due to certain key factors. Weight gain is one of the symptoms which manifests in the patient, and the probable cause of this is the use of the Tacrolimus. The gain in weight is a side effect linked to this disease. When a patient receives a kidney transplant, they move from the restrictive diet to a non-restrictive diet, and this can contribute to the weight gain.

In addition, the patient experiences the decline in his urine, and this seems to occur because the rejection can interfere with the kidney function, and adversely affect the ultrafiltration process (Bhatti & Usman, 2015). The impaired kidney can only perform limited functions, and this can cause the interruption of the supply of the energy to the body. The use of the Imuran medication is associated with fatigue, and it might be the reason for the patient’s tiredness.

Genes Linked to the Disease’s Development

Genetics is one of the factors which determine one’s risk of experiencing acute kidney transplant rejection, and a number of genes can cause one to develop this condition. The gene, cytokine polymorphism is one these genes. It alters the degree of gene’s expression, or even create a demarcation between a gene and given haplotype. For this reason, it can cause the development of the acute kidney transplant rejection. The C3 gene also plays a role in the development of this rejection condition. It particularly controls the immune responses, and it can cause the acute urine rejection (Dorr et al., 2018).

The Immunosuppression process

The immunosuppression process occurs when the body’s immune capacity declines, and it can occur when one receives medications. During this process, the body experiences a decline in the capacity of the body to respond to infections, and this makes the body to be susceptible attack by these infections. This suppression occurs in stages, and it starts with the induction, and during this induction, the therapist induces and controls the medication the patient receives. This process is accompanied by the maintenance therapy which involves adjusting the quantity of the medication in one’s system to suppress their immune system (Bhatti & Usman, 2015).

Conclusion

In overview, the alteration of the one’s physiological health can help when transplanting an organ, and while this process is critical in avoiding rejection, the rejection may still occur following the transplant. This rejection may occur even when one is on medication. The risks associated with the antirejection medications include fatigue, weight gain and reduced output of the urine. Some of these side effects, however, can also result from the acute kidney transplant rejection disease.

References

Bhatti, A. B., & Usman, M. (2015). Chronic Renal Transplant Rejection and Possible Anti-Proliferative Drug Targets. Cureus, 7(11), e376.Doi: https://doi.org/10.7759/cureus.376.

Dorr, C. R., Oetting, W. S., Jacobson, P. A., & Israni, A. K. (2018). Genetics of acute rejection after kidney transplantation. Transplant international : official journal of the European Society for Organ Transplantation, 31(3), 263–277. Doi: https://doi.org/10.1111/tri.13084.

Procópio, F. O., Cruz, V. P., Scavonec, C. M., Giunta, L., Pestana, J. O., Roza, B. A., & Schirmer, J. (2014). Fatigue effects in daily life activities of kidney transplant recipients. Transplantation proceedings, 46(6), 1745–1749.Doi: https://doi.org/10.1016/j.transproceed.2014.05.024.

Alternative Expert Answer and Explanation

Altered Physiology and Kidney Rejection

Reasons for the Symptoms

Reflecting on the case study, the 34-year old patient shows certain clinical manifestations such as weight gain, and there are key reasons for this. The patient uses Tacrolimus, a medication that can cause one to gain weight. However, this can also stem from the kidney transplant. When one undergoes this clinical procedure, their diet changes from the restrictive one to a non-restrictive type.

The drop in the patient’s urine level is another clinical manifestation noticeable in the scenario. This occurs due to the rejection which has a tendency of interfering with how the kidney functions. This alters the ultrafiltration process (Shaw et al., 2020). The patient’s fatigue, however, seems to stem from the Imuran medication he takes considering that this is a side effect of the medication.

Genetics and the Disease

A wide spectrum of factors can cause acute kidney transplant rejection (AKTR), and genetics forms part of these factors. The C3 gene is an example of the genes which one can associated with the AKTR. It is particularly responsible of controlling the immunological responses, and alteration to this gene structure can result to AKTR. Cytokine polymorphism can equally contribute to the condition. This is because it has a tendency of altering the expression of the gene (Erpicum et al., 2017)

Immunosuppression Process

In certain cases when a patient uses some medications, they may experience the weakening of their immune capacity. At this point, the patient’s body undergoes changes, and it becomes difficult for it to respond effectively to clinical interventions. At this state, the susceptibility of one to the infections rises.

To address this problem, a caregiver induces and manages the patient’s medications, and this constitutes the first step of immunosuppression (Wiseman, 2016). They then perform maintenance therapy, and at this point, they adjust the amount of the drug as a means of suppressing the patient’s immunity.

References

Erpicum, P., Hanssen, O., Weekers, L., Lovinfosse, P., Meunier, P., Tshibanda, L., Krzesinski, J. M., Hustinx, R., & Jouret, F. (2017). Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients, part II: omics analyses of urine and blood samples. Clinical kidney journal, 10(1), 106–115.Doi: https://doi.org/10.1093/ckj/sfw077.

Shaw, B. I., Cheng, D. K., Acharya, C. R., Ettenger, R. B., Lyerly, H. K., Cheng, Q., Kirk, A. D., & Chambers, E. T. (2020). An age-independent gene signature for monitoring acute rejection in kidney transplantation. Theranostics, 10(15), 6977–6986. Doi: https://doi.org/10.7150/thno.42110.

Wiseman, A. C. (2016). Immunosuppressive Medications. Clinical journal of the American Society of Nephrology : CJASN, 11(2), 332–343.Doi:  https://doi.org/10.2215/CJN.08570814.

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