Post-Transplant Update: 13 April 2020

Well, last week definitely did NOT go as planned.

In my last post I stated that the doctors at the Kidney Clinic had ordered a Renal Angiogram. Unfortunately, the hospital Radiologist wanted to do a Renal Ultrasound before doing an Angiogram in order to rule out Hydronephrosis, which is either water surrounding the kidney, or any inflammation of the kidney itself. 

So, I went in on Wednesday for the ultrasound, which ended up ruling out either condition. Then, I was scheduled for the Renal Angiogram on Thursday Afternoon.

The Angiogram started out a bit rocky when the radiologist innervated a nerve on the insertion of the cannula. No, this was NOT negligence on the part of the radiologist; I apparently have a nerve that is in the wrong place.
Anyhow, the nerve hit caused an intense pain deep in my R thigh (the cannula insertion was on the R) that went all the way down to my toes. This pain persisted despite the fact that I was given Fentanyl for the test. The extra pain made the whole test far worse than any other Renal Angiogram I have ever had. 
The test showed that there was no additional scar tissue within the Renal Artery. However, the artery had settled into a position that actually looks like a kink in a hose, but which allows for proper perfusion of the kidney. All internal pressures within the artery were in good shape. So, the artery in NOT the answer to this riddle.

My post-test recovery took about four hours, and I was sent home.

The next day--Friday--my post-test recovery was miserable as that leg pain persisted, and the insertion site itself was also quite painful. Plus, because of the pain I endured during the test, my TMD was triggered big time, and I endured a terrible headache all day despite meds.
Then on Saturday, I felt like garbage all day. I'm talking intense nausea, stomach aching, feeling hot despite a 95.9 temperature, continued leg pain and just feeling lousy all over throughout the entire day.
Sunday was better, but I thought it best to avoid food altogether until the evening; even then I ate only a lite dinner.
I awoke today feeling much better.

This morning I did my labs.  There is mixed news.

13 April 20 Labs:

*Creat:   3.05 (+0.39 over last week) 

*HCT:   38.1 (+2.6) IR

*Hemo:   12.1 (+0.9) High

*Lymph:   11.3 (-5.9) Low (What a surprise! :ol)

*Lymph ABS:   0.8 (-0.1) Low

*Neut:   76.6 (+4.3) High

*Neut ABS:   5.6 (+1.8) IR

*RBC:   4.25 (+0.29) Low

*WBC:   7.3 (+2.0) IR, but way up

*BUN:   39 (NC) Very High

*CA:   9.0 (NC) IR

*GFR:   22 (-1) Extremely Low

*Gluc:   116 (!) That's unusual

*K+:   4.4 (+0.4) IR

*NA+:   137 (-1) IR

*MG:   2.0 (-0.2) IR

*Phos:   4.1 (+0.2) IR
          NC= No Change     IR= In Range

Urinalysis was exactly the same as last weeks'.

On the 'good' side:

The Hematocrit unexpectedly rose for the second week in a row, and is now solidly in the preferred range. 
Accordingly, the Red Count also rose following two weeks of losses. Though still below the desired range, it is nice to see this lab up here once more.

On the 'not-so-good side:

The White Count rose two full points despite the increased Myfortic. This rise could be coincidental as tomorrow (14 April) is my next infusion of Belatacept, and with the kidney already struggling, the lack of Belatacept may be too much for the kidney. Next weeks' labs will be a telling point.

As expected, the Lymphocytes dropped again, but not as far as I'd expected. 

Lastly, the Creatinine. Though it is a modest rise overall, the fact that this went above 3.0 again in spite of the increased meds is very concerning to the Transplant doctors.

So, they ordered a test for the BK virus; just to rule that out. I have never had a positive BK result, but it still needs to be addressed. I will do that test tomorrow before my infusion.
Assuming that test comes back as negative, the doctors are looking to try a home-based increase of Prednisone for a few days, then see what my labs are next week. Based on that, I'll either have another med change, get a Renal Biopsy or be admitted to the hospital for a rejection or a rejection episode. So, next week will be pivotal.

What fun!  :ol

I will update this entry later this week when I know the BK results and Prednisone regimen. 

I hope that you are all staying healthy, strong and doing what is required to keep this Chinese virus from infecting you and your loved ones.

So, until later this week...

Good Health to All!

ScottW