Case 12: Introduction

History of Present Illness (HPI)

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A 40-year-old woman with past medical history of human immunodeficiency virus (HIV), end stage renal disease (ESRD) secondary to HIV nephropathy  who received a deceased donor kidney transplant less than one year ago who presents to your clinic with a complaint of intermittent episodes of gross hematuria for the past week week

About one month ago, a biopsy of the patient’s kidney transplant revealed acute cellular rejection (ACR) IIA  and was treated with anti-thymocyte globulin (ATG) and glucocorticoids. 2 weeks ago, her creatinine was 1.4 mg/dL.

She feels well but is worried about the blood she has been seeing in her urine. She has not had fever, nausea, vomiting, chest pain, abdominal pain, diarrhea, or extremity swelling. Her appetite has been normal and she has had normal oral intake. She lives alone and has 2 dogs. She does not use tobacco, alcohol, or illicit drugs. She reports adherence with her immunosuppressants.

You repeat her labs in the clinic, and her creatinine is now 2.2 mg/dL.

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