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Kidney Transplant

Treatment

Treatment 1994

By March, 1994 Sam's blurred vision was becoming a serious problem, interfering with his driving and employment. His wife urged him to see the primary care physician. Upon finding malignant hypertension and serum chemistries elevated for creatinine and BUN, showing the beginning of chronic renal insufficiency, his physician ordered a renal ultrasound, made a tentative diagnosis of glomerulonephritis and referred his patient to a nephrologist.

Further testing with a renal arteriogram showed normal blood flow to kidneys with no vascular abnormalities, no atherosclerosis, and normal-sized kidneys. The nephrologist made a working diagnosis of focal segmental glomerulosclerosis based on a history of hypertension and abnormal levels of blood and protein in the urine. This diagnosis is a form of glomerulonephritis in which the kidney filters, nephrons, become scarred due to a malfunction of the body's immune system. No biopsy was ordered for confirmation.

The nephrologist discussed the serious nature of Sam's situation with him and his wife, the prognosis of eventual renal failure necessitating dialysis and renal transplantation and the extreme importance of control of hypertension to extend the life of patient's kidney function as long as possible. From this point on, Sam began to see his nephrologist regularly, usually with his wife present.

Regimen as of March, 1994:

• Cardizem®
• Tenex®
• Lopressor®

With strong family support and physician encouragement, Sam remained compliant with appointments and medications throughout the rest of 1994. From 1994 through 1996, management goals were to prolong kidney function as long as possible and keep the patient working and functional. Home blood pressures were monitored with the patient reporting to the nephrologist if diastolic pressure was over 90.

Objective:

State the process by which the patient is diagnosed and referred.