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Reflux Nephropathy
Reflux Nephropathy
Reflux Nephropathy
Reflux Nephropathy
Reflux Nephropathy
Reflux Nephropathy
Reflux Nephropathy
Reflux Nephropathy
Reflux Nephropathy
Reflux Nephropathy
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Reflux Nephropathy

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  • 1. A Case of Reflux Nephropathy A difficult case
  • 2. Mrs LC
    • Transferred from Pendlebury aged 17 in Feb 1991
    • Initially presented with renal failure aged 12
    • Renal transplant in 1989
    • Had some “early problems” but well at that time (creat 149)
    • Renal function deteriorated (creat 260) and she was treated for infection.
    • Biopsy showed cyclosporin nephrotoxicity.
    • Her function was stabilised and she continued with follow up as usual.
  • 3. Problems begin
    • Noted on several letters in 1991-1992 that her weight and blood pressure was low.
    • In 1992 she went down to 5 stone & was referred to psychiatry with anorexia.
    • At that time her attendance was sporadic.
    • July 92 – E coli UTI
    • Aug 92 – 2x admission with UTI
    • March 93 – UTI
    • Commenced on prophylactic antibiotics.
    • Aug 93 – admitted with UTI & urogenital HSV
    • Creatinine remains stable at 192.
  • 4. Baby Boom
    • Commenced on Oral Contraceptive pill
    • Risks of pregnancy discussed
    • Rick of cervical cancer discussed.
    • No further UTI’s for a reasonable time.
    • April 1994 – referred to Obstetrician at Preston for close supervision of first pregnancy
    • Pt aware of increased risk of pre-eclampsia
    • Aware cyclosporin may increase risk of in-utero growth retardation.
    • Creatinine 168 at this time
  • 5. A bouncing baby girl
    • The pregnancy proceeded without major complication
    • Elective caesarean performed since pt 5ft tall and breech presentation
    • Healthy Child delivered Nov 1994
    • Post natal creatinine 168
    • Persistently low cyclosporin levels and poor compliance.
    • July 1996 – creat increased to 240
    • Biopsy showed acute rejection + cyclosporin toxicity
    • Further episode Pyelonephritis
    • Creat improved to 170 by september
  • 6. The patter of tiny feet…..
    • Became pregnant in sept 1996
    • 3 UTI’s during pregnancy
    • Admitted at 33 weeks – hydramnios
    • Personal problems & struggled with tiredness
    • Healthy girl delivered in april 1997
    • Post partum creat 141
    • Advised not to risk further pregnancy
    • Episodes of UTI over next few years.
    • Declined investigations to assess for ongoing reflux
    • Pregnant again in Nov 2000 (creat 133)
  • 7. Little bundles of joy….
    • Another girl delivered april 2001
    • Uneventful pregnancy and delivery
    • Post natal creat 157
    • Sterilisation recommended
    • 2 further UTI’s
    • Pregnant again in March 2002
    • Delivered early as developed ureteric obstruction Nov 02
    • Post natal creat 170
    • Fourth girl – found to have reflux
  • 8. Screening and problems
    • Child 4 has reflux and so others are screened.
    • Child 2 also found to have reflux ( now aged 6)
    • Child 4 has major problems due to tracheomalacia
    • Mrs LC now struggling with 4 children aged 0-8
    • Neglecting herself while child 4 has regular admissions to hospital.
    • Creatinine declines rapidly: 209 Jan 03
    • 396 june 03
    • 921 Aug 03
    • Biopsy shows allograft nephropathy
    • High dose steroids tried
  • 9. Things come to a head
    • Admitted August with symptomatic uraemia
    • Restarted dialysis via temporary line
    • UTI’s continued
    • Grand mal seizures – EEG abnormal therefore commenced valproate
    • Major social issues
    • Now back on maintenance Haemodialysis programme
    • Problems with access but fistula successfully formed jan 04
    • Back on transplant list.
  • 10. Issues
    • Multiple difficulties faced by young people with renal transplants
    • Ongoing problems with recurrent UTI can exist after transplantation
    • Pregnancy may be a risk in all patients with renal failure
    • Caring for a large family has an impact on an individuals health
    • Reflux nephropathy is potentially hereditary.

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