A week after kidney transplantation the client develops a temperature of 101, the blood pressure is elevated, and the kidney is tender. The X-ray results show the transplanted kidney is enlarged. Based on these assessment findings, the nurse would suspect which of the following?
A. Acute rejection
B. Chronic rejection
C. Kidney infection
D. Kidney obstruction
Correct Answer: A. Acute rejection
Acute rejection most often occurs in the first two (2) weeks after transplant. Clinical manifestations include fever, malaise, elevated WBC count, acute hypertension, graft tenderness, and manifestations of deteriorating renal function. It is related to preexisting circulating antibodies in the recipient’s blood against the donor antigen (usually ABO blood group or HLA antigen), which is present at the time of transplantation. These antibodies attack and destroy the transplanted organ as soon as or within a few hours after allograft is revascularized.
Option B: Chronic rejection occurs gradually during a period of months to years. Chronic rejection is related to both immune and nonimmune mediated factors. The primary risk factor for chronic rejection is non-compliance with immunosuppressive medication. It can be either chronic antibody-mediated rejection, which is mainly related to the presence of donor HLA-antigens donor Specific Antibody (DSA) or Chronic cellular rejection, which is uncommon.
Option C: Kidney infection (pyelonephritis) is a type of urinary tract infection (UTI) that generally begins in the urethra or bladder and travels to one or both of the kidneys. A kidney infection requires prompt medical attention. If not treated properly, a kidney infection can permanently damage the kidneys or the bacteria can spread to the bloodstream and cause a life-threatening infection.
Option D: Although kidney obstruction can occur, the symptoms presented in the question do not relate specifically to these disorders. The most common cause for blockage is a kidney stone, but scarring and blood clots can also cause acute unilateral obstructive uropathy. A blocked ureter can cause urine to go back up into the kidney, which causes swelling. This backflow of urine is known as vesicoureteral reflux (VUR).
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