This case involves an obese 51-year-old male in Colorado who was admitted for ischemic chest pain. The patient had an EGD that was negative. The patient was found to have a polyp in the colon that was removed and an ulcer in the small intestine was noted and biopsied. After the colonoscopy, the patient had severe abdominal pain and was hypotensive. A CT scan showed evidence of a splenic laceration and resulting blood in the peritoneal cavity. The patient was taken to the operating room. During the procedure, the patient’s kidney was accidentally removed with the spleen. The patient later developed an infection secondary to his kidney removal.
Question(s) For Expert Witness
1. How often do you see patients who have had a surgically removed kidney?
2. In general, what aspects of a patient's medical chart are important in determining any effect removal of a kidney would have on a patient's future prognosis?
Expert Witness Response E-000014
Over my 41 years of practice as a physician, and specifically as a nephrologist since 1982, I have seen patients with nephrectomies for cancer, kidney donation, and surgical incidental iatrogenic complications. I have seen this occur several times. It would be difficult to say how many per year. With the advent of laparoscopy and improvement in renal biopsy techniques they occur less frequently. My research and clinical focus has been two-fold as specifically related to this case. I have also been the principal investigator, consultant, and/or researcher for projects to measure hormones that are affected by pharmacologic and non-pharmacologic therapies to prevent renal failure and preserve kidney function. In this case the combination of renoprotection and experience in having one vs two kidneys as well as my experience in this patients "presumed nephrosclerosis" (the blood vessel disease in the carotids and heart are everywhere including the kidneys) all allow me a greater understanding to allow the courts and clearer picture of how the nephrectomy will impact this patient's past, current and previous health.
