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Kidney Transplant

Introduction

History

In August, 1986 Sam went to his primary care physician for a college sports physical. Previous high school physical exams had been normal. He had no known allergies, had never smoked, did not use any prescription or street drugs, and had no prior medical or surgical history. He chewed one can of tobacco weekly. His blood pressure was elevated with a systolic level of 170. Urinalysis revealed microscopic hematuria with a urine dipstick of 3+ hematuria and 1+ albumin. He had no symptoms and had merely been reporting for a routine sports physical to participate in varsity basketball. His vision was 20/20 in both eyes. Blood tests showed creatinine (muscle waste) 1.5, BUN of 20 and Hct (hematocrit, red blood cell count) of 46.2%, not suggestive of any advanced kidney disease. The primary care physician ordered an IVP. The IVP did not show stones or abnormality that would explain the cause of blood loss. The primary care physician prescribed anti-hypertensive medications to control Sam's blood pressure and decided to refer him to a specialist.

Sam was referred to a teaching hospital for nephrology evaluation. Blood pressure was better controlled at 130/70, a repeat IVP was within normal limits, and CBC and blood chemistries were all normal. Urine testing confirmed the presence of red blood cells and protein, indicating possibility of an underlying kidney disease. A biopsy was requested to get a definitive diagnosis. Sam refused, probably a normal response from an 18-year-old. He didn't want a needle put in his kidney and said physicians should be able to find out what his problem was "just from the tests they had already done." Since he felt fine, a biopsy seemed unnecessary to him.

From that point on, Sam was seemingly normal and too busy to bother with health concerns. He was dating his high school sweetheart, helping his father on the farm, playing sports and preparing to start college. Being a normal late adolescent, other priorities evolved and since he felt well, he never returned to a physician for follow-up.