NURS 6501 Week 2 Module 1 assignment Case Study Analysis

NURS 6501 Week 2 Module 1 assignment Case Study Analysis

Pathophysiology of Presenting Problems

Rejection process is a major barrier to transplantation medicine, which is associated with the recipient’s immune system recognizing a graft as foreign and mounting an immune response against it. A & Fitzgerald (2019) define rejection as the process whereby antibodies and T lymphocytes secreted against graft antigens react against and destroy the graft. Major differences between the host’s and donor’s antigens that cause transplant rejections are within human leukocyte antigen (HLA) alleles, as described by Claeys and Vermeire (2019). Grafts can be allografts, xenografts, or autografts. Allografts involve the exchange of grafts between individuals of the same species, e.g., kidney transplant, as in the case above.

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The high polymorphism of HLA genes creates significant differences among individuals (Claeys & Vermeire, 2019). During transplantation, the recipient’s T cells will recognize the antigens of the donor from the graft through direct and indirect alloantigen recognition. According to Claeys and Vermeire (2019), direct recognition involves presenting the graft’s antigens directly to the recipient’s T cells via the graft’s antigen-presenting cells. Indirect recognition involves the host’s APCs picking the graft antigens, processing them, and presenting them to the host’s T cells. Both processes stimulate CD8+ T cell activation, leading to the development of cytotoxic T cells and CD4+ cells, which produce T helper 1 cells as cytokines that take part in the rejection of allografts, as asserted by Claeys & Vermeire (2019).

Graft rejection can be acute, hyperacute, or chronic. Acute rejection, which occurs within days, weeks, months, or years of transplantation, is effected via T cells and antibodies that are activated by graft alloantigens (Claeys & Vermeire, 2019). The patterns of acute rejection are acute cellular rejection, where there is direct destruction of graft cells by the CD8+ CTLS or secretion of cytokines by CD4+ cells that cause inflammation and, thus, graft damage (A & Fitzgerald, 2019). In antibody-mediated rejection, A and Fitzgerald (2019) assert that antibodies attach themselves to the vascular endothelium and cause complement activation via the classical pathway. This leads to inflammation and endothelial damage, leading to graft failure. Any of the two mechanisms would have contributed to graft rejection in the patient.

The inflammatory response to the kidney causes acute kidney injury (glomerulonephritis), where there is damage to the glomerular capillary filtration membrane, which causes a decrease in urine output (Naik & Shawar, 2020). Weight gain would be ineffective excretion of fluids from the body due to failing kidneys; hence, there is salt and water retention causing weight gain. Naik & Shawar (2020) cite that the development of fever is due to the inflammatory response causing graft rejection, which is associated with pyrogen release from macrophages and necrotic cells from the transplanted kidney. Fatigue is secondary to altered metabolism, the burden of morbidity, and fever. Kidney injury is associated with uremia, associated with fatigue, malaise, heart failure, pruritus, and neurological manifestations, contributing to the patient’s presentation (Naik & Shawar, 2020).

Genes Associated with the Disease

The major histocompatibility molecules (MHC) HLA alleles are associated with transplant rejection. The polymorphism of HLA genes contributes to the differences in individuals, and this is the basis for matching between individuals before transplantation. The HLA matching should match more than four of the alleles, namely (HLA-A, B, C, DR, DQ, and DP). In a study reported by Salvadori (2023), it was established that polymorphism of many genes, including CYP3A5, CCR5, FOXP3, TGF Ꞗ, and vascular endothelial growth factor (VEGF), are majorly pronounced inflammation, which leads to acute rejection. Similarly, Fan et al. (2020) established that polymorphism in gene CD 28 is associated with acute kidney allograft rejection. Other genes screened in the study associated with the rejection of kidney transplants include SDHA, CYC1, UQCRQ, UQCRC1, and SDHB.

Immunosuppression Process and Its Effect on Body Systems

According to Fan et al. (2020), immunologic factors are essential in the outcome of patients with kidney transplants. Immunosuppressive medications are vital for the rejection of transplantations, survival, and quality of life of patients with transplants. During the process of immunosuppression, induction is done using monoclonal or polyclonal antibodies, and then maintenance is done with agents such as cyclosporin or tacrolimus, prednisone, and mycophenolate mofetil (Fan et al., 2020). The overall goal of immunosuppression is to prevent graft rejection. However, it may have consequences for the body systems.

In their article published in the Journal of Immunological Sciences, Claeys and Vermeire (2019) report that agents that are used in immunosuppression can have severe consequences, such as cancer and infections. Azathioprine may cause leukopenia, thrombocytopenia, hepatotoxicity, nausea, vomiting, and a high risk of malignancy. Cyclosporin is associated with neurotoxicity, nephrotoxicity, predisposition to diabetes, cancer, and electrolyte imbalances. Tacrolimus produces similar side effects as cyclosporin. Therefore, the effects of immunosuppression can be localized to any body system.

References

A, A., & Fitzgerald, B. M. (2019, February 22). Acute Transplantation Rejection. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535410/

Claeys, E., & Vermeire, K. (2019). Immunosuppressive drugs in organ transplantation to prevent allograft rejection: Mode of action and side effects. Journal of Immunological Sciences, 3(4). https://doi.org/10.29245/2578-3009/2019/4.1178

Fan, P., Zhang, W., & Liu, Y. (2020). CYC1, SDHA, UQCRC1, UQCRQ, and SDHB might be important biomarkers in kidney transplant rejection. Clinica Chimica Acta, 507, 132–138. https://doi.org/10.1016/j.cca.2020.04.013

Salvadori, M. (2023). Role of Biomarkers in Detecting Acute Rejection in Kidney Transplantation. Transplantology, 4(1), 18–21. https://doi.org/10.3390/transplantology4010004

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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.

An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

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, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.

The Assignment

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.

Week 2: Module 1: Case Study Analysis Assignment

Scenario : A 34-year-old Hispanic-American male with end-stage renal disease received 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 101ËšF. He was evaluated by his nephrologist, who diagnosed acute kidney transplant rejection.

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.

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