Clinical case: the impact of renal transplantation in the patient with renal pathology and gout

Abstract

Introduction:Renal transplantation is a radical treatment option for patients with chronic kidney disease (CKD), significantly impacting those with coexisting renal pathology, such as gout. The use of immunosuppressants after transplant can increase the risk of gout recurrence, and medications that reduce uric acid production are crucial to prevent further renal complications. Gout can affect the kidneys by forming uric acid crystals, leading to conditions such as urate nephropathy, uric nephrolithiasis, and CKD. Currently, 121 renal transplant patients are under care at the Republican Clinical Hospital Timofei Moșneaga. Objectives: This case aims to describe the stages of organ and tissue procurement from brain-dead donor, kidney transplantation, and the subsequent evolution, considering comorbid pathologies. Materials and Methods: A clinical case is described involving a patient who underwent kidney transplantation at the Republican Clinical Hospital Timofei Moșneaga, focusing on comorbidities and post-transplant progression. Results:A 48-year-old male underwent kidney transplantation from a brain-dead donor on December 17, 2022. The donor women, 65-year-old admitted to the Municipal Clinical Hospital Sfânta Treime with a diagnosis of a cerebrovascular accident with evolution in confirmed brain death. The recipient was admitted to the Republican Clinical Hospital Timofei Moșneaga on August 23, 2023, with fever, chills and joint pain. Despite initial treatment, his condition worsened, leading to transfer to the intensive care unit, where biological death was declared on August 30, 2023. The cause of death was determined to be pulmonary sepsis, irreversible toxic-septic shock, and Pseudomonas aeruginosa infection. Pre-existing conditions included chronic glomerulonephritis, hypertension, and chronic gout. Conclusions: 1. After compatibility testing, 2 patients with end-stage renal failure were transplanted and the tissues procured (cornea, blood vessels) after processing at the Human tissue bank of the Clinical Hospital of Traumatology and Orthopedics were transplanted into 2 patients with corneal ulcers. 2. Kidney transplantation can significantly improve renal function and mitigate the effects of gout on the kidneys. 3. Careful management of uric acid levels and immunosuppressive therapy is essential to prevent gout recurrence and other complications.