Case Published: January 2022
Case Submitted By: NephSIM Nephrons Tubule 9 (2021)

Authors: Eric Xu, Kirin Munir, & Margaret DeOliveria
Faculty Mentor: Amy Yau, Amanda Leonberg-Yoo

History of Present Illness (HPI)

A 24-year-old woman with a past medical history of simultaneous pancreas-kidney transplant 2 years ago (type 1 diabetes mellitus, end stage kidney disease due to diabetic nephropathy), presents to clinic with a several day history of diarrhea. Three days ago, she started having 3-4 non-bloody bowel movements daily after attending a family event.  She suspects food poisoning and took “a few ibuprofens” due to abdominal cramps. The diarrhea is now improving. She currently does not have fever, chills, abdominal pain, urinary symptoms, sick contacts. 

Her transplant surgery and post-operative course were uncomplicated, and she has been doing well since transplant. Labs on routine follow up visit 1 month ago were within normal limits (creatinine 0.8 mg/dL), though on physical exam she was noted to be mildly hypertensive at 150/80 mmHg and was started on nifedipine 30 mg daily. 

She has been adherent to all of her current medications:

• mycophenolate mofetil 1000 mg twice daily
• tacrolimus 3 mg twice daily
• prednisone 5 mg daily
• trimethoprim-sulfamethoxazole (TMP-SMX) single strength daily 

She undergoes basic laboratory testing in clinic and is referred to the Emergency Department for acute kidney injury (creatinine 2.1 mg/dL). 

Click here for the physical exam!