Case 12-2007: A 56-Year-Old Woman with Renal Failure after Heart–Lung Transplantation

A 56-year-old woman was admitted to the hospital because of renal failure. Ten years earlier, heart–lung transplantation had been performed because of primary pulmonary hypertension; her immunosuppressive regimen consisted of cyclosporine, prednisone, and azathioprine. Her medical history included glomerulonephritis at the age of 19 years, which resolved, and recurrent urinary tract infections. Renal function had been deteriorating slowly since the transplantation, and proteinuria had developed. A diagnostic procedure was performed. A 56-year-old woman was admitted to the hospital because of renal failure. Ten years earlier, heart–lung transplantation had been performed because of primary pulmonary hypertension. Renal function had been deteriorating slowly since the transplantation, and proteinuria had developed. Presentation of Case A 56-year-old woman with a history of primary pulmonary hypertension and heart and lung transplantation was admitted to the hospital because of renal failure. When the patient was approximately 43 years old, a diagnosis of primary pulmonary hypertension was made at another institution; progressive hypoxemia and polycythemia developed, and 3 years later (10 years before admission), heart and lung transplantation was performed at another hospital. The patient's symptoms improved, and oxygenation and hemoglobin levels returned to normal. Her medications included prednisone (10 mg daily), cyclosporine (225 mg twice daily), azathioprine (75 mg per day in divided doses), . . .