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• ESRD—secondary to PKD and failed previous transplant

• One prior renal transplant from husband in 1995, which failed secondary to chronic allograft nephropathy in 2004 (presumably from multiple rejection episodes within the first few years after transplant).

• For the previous transplant the patient was maintained on cyclosporine, mycophen-olate, and prednisone.

• Hypertension; hyperlipidemia; insomnia

FH: Father died of a myocardial infarction at age 53, while her mother is alive and living with hypertension, systemic lupus erythematosus, DM, and osteoporosis at the age of 75.

SH: The patient works as a secretary. Was a heavy tobacco user (45 pack years), but quit 3 years ago. She denies alcohol and IV drug use.

Admission Meds: Calcitriol 0.25 mg by mouth once a day; calcium acetate 1,334 mg by mouth three times a day; ferrous sulfate 325 mg by mouth once a day; epo 4,000 units IV every hemodialysis session; zocor 20 mg by mouth once a day at bedtime; metoprolol 100 mg by mouth twice a day; ASA 81 mg by mouth once a day; zolpidem 10 mg by mouth once a day at bedtime

Allergies: Codeine (upset stomach); penicillin (hives); sulfa (rash) Misc:

• CMV serostatus: Donor is CMV immunoglobulin G (IgG) positive

• CMV serostatus: Recipient is CMV IgG positive Identify your treatment goals for this patient.

Create a plan for induction therapy (i.e., would you recommend induction therapy, if so, which agent?).

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