Hello. I am a home health nurse and need some information on estimated GFR after renal surgery. My patient, 62 years old, had a kidney transplant 10years ago. He recently had a toe amputated and has had a MI in the last 2 weeks. He underwent heart cath and was found to have 5 blockages in his heart. The doctors are delaying surgery d/t the pt. having MRSA from the toe amputation. The pt. came home with PICC line and is taking abx daily at home via IV to get rid of the infection. I drew blood work on him this last week. His creatinine was 1.2 and his BUN was 23. His estimated GFR was 65, which shows him in Stage 2 Kidney disease, showing kidney damage and mild decrease in GFR. For a healthy kidney, the GFR estimated is 90 or greater. My question is does having a kidney transplant effect the GFR estimated or is my pt. losing function in his transplanted kidneys? Any info, would be greatly appreciated. Thanks.
Jan 28, '07
Your pt has a decrease in renal function. It maybe temporary or permanent. Contrast and antibiotics may cause a bump in the BUN and Cr as well as dehydration. Ironically enough the antirejection meds given after transplant are also nephrotoxic. A GFR of 60 still 10 yrs post transplant is really very good. Dialysis is considered necessary when the Cr clearance is down around 12-15.
Jan 30, '07
I understand that my pt has a decrease in renal function. My question is what is the normal estimated GFR after renal transplant. Is it normal to have a reduced estimated GFR 10 years post-transplant? Thanks...
Jan 31, '07
Well, I did more bloodwork on my pt. today. His BUn is 23 and Creatinine. His estimated GFR has dropped from 65 last week to 59 this week. I think I am going to just call his nephrologist tomorrow.
Jan 31, '07
That's what I would do also. It may be that his transplanted kidney isn't working as well as it used to or it could be baseline function for this kidney. However, without a hx of the kidney, no one could say except for his nephrologist.
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