Kidney Transplant in a 26-Year-Old Nigerian Patient with Sickle Cell Nephropathy

Sickle cell nephropathy (SCN) is a common complication of sickle cell disease (SCD). It has variable presentation, ranging from hyposthenuria to end-stage renal disease (ESRD). Management of ESRD in SCD patients is froth with multiple challenges which has potential to impact negatively the outcome of the patient. Kidney transplant is the preferred renal replacement therapy in these patients. The objective of this case study is to report kidney transplant in a Nigerian young man with sickle cell nephropathy and to highlight the outcome and the challenges to kidney transplant in this patient. The index case is a 26-years-old sickle cell disease patient with ESRD complicated with cardiovascular, pulmonary, immunological, and infective challenges. These conditions were controlled, and the patient had a successful live-related kidney transplant. Kidney transplant is a viable option for sickle cell disease patients with ESRD. 1. Introduction Sickle cell disease (SCD) is a haematological disorder associated with multisystemic complications and manifestations [1]. Sickle cell nephropathy (SCN) leads to both renal functional disturbances and anatomical alterations. The prevalence of renal disease (SCN) in SCA patients is about 25% [2]. The clinical spectrum of SCN include proteinuria, haematuria, nephrotic syndrome, acute renal failure, and chronic progressive renal failure leading to end-stage renal disease (ESRD). Mechanisms of SCN include fortuitous occurrence, iron overload and its subsequent deposition in the kidney parenchyma, immune complex formations, and focal segmental glomerulosclerosis (FSGS) associated with glomerular hyperfiltration and intrinsic glomerular capillary injury [3, 4]. Treatment of sickle cell nephropathy is fraught with many challenges as a result of antecedent complications prevalent in sickle cell disease patients. The outcome of treatment is usually variable. Renal replacement therapy is inevitable in SCN patients with uraemia, circulatory overload including pulmonary oedema and ESRD. Kidney transplant is usually renal replacement therapy of choice for eligible patients with ESRD barring other challenges and limitations. SCD and prevailing complications worsen these challenges, further limiting the prevalence of kidney transplant in these patients. However, in Nigeria and most developing countries kidney transplant is not readily available as a result of some factors which include poverty, ignorance, lack of transplant centres, and lack of donors [5]. There are only 4 kidney transplant centres in Nigeria performing less than 20