CASE STUDIES
Help me doctor, which renal replacement modality is best for me?
By W. Van Biesen
The patient accepts the proposal to increase the dialysis schedule to 5 exchanges of 2.5 litres per day. Despite this increased dialysis dose for some months, the serum creatinine, urea and phosphorus levels remain very high. After 22 months of therapy a potential cadaveric kidney becomes available. The donor is a 59 year old lady who has been declared brain dead after an intracerebral bleeding, potentially related to hypertension and/or stroke. The cold ischaemia time is calculated to be 22 hours before the time the kidney would arrive at our transplantation unit, and there is a 3/6 HLA mismatch. At admission in the donation centre, the serum creatinine of the donor appeared to be 1.5 mg/dl. and there was mild proteinuria in the urine sample, taken immediately after admission. The donor kidney sizes, determined by bed-side ultrasound, was 9.5 and 10.0 cm, respectively. No further history of this donor is available. A pre-transplant serum sample of the recipient after admission in the emergency room shows a hypercalcaemia (Ca: 6.1mEq/l) and hyperphosphataemia (Phosphorus: 6,3mg/dl).
