Introduction: This case presentation focuses on a 17-year-old girl with a complex medical history, highlighting the intersection of kidney transplant management and an eating disorder. Diagnosed with nephrotic syndrome (NS) at 2 years old, she progressed to end-stage kidney disease (ESKD) due to Focal Segmental Glomerulosclerosis (FSGS). At age 14, she underwent a deceased donor kidney transplant but experienced immediate disease recurrence, requiring daily plasma exchange (PLEX) treatments. Additionally, at 16, she was diagnosed with anorexia nervosa (restricting type), significantly impacting her treatment adherence and overall medical outcomes. This case illustrates the challenge of managing both kidney transplant and anorexia nervosa, underlining the importance of integrated care strategies.
Methods: A multidisciplinary management approach was adopted to address the challenges faced by the patient. This included simplifying the patient’s complex medication regimen to ease the burden of treatment adherence, implementing medication observation with a local pharmacy, and parental support in preparation and monitoring of medications to ensure compliance with immunosuppressive therapy, particularly Tacrolimus. The patient was enrolled in an eating disorder program, which offered psychotherapy for both the patient and her family. Weekly meetings with the transplant team were held to monitor her progress and adjust the treatment plan as necessary. Nutritional support was tailored to meet the challenges of her weight gain, with careful consideration of her renal health. Key metrics, including Tacrolimus levels, kidney function, weight, and parental involvement, were regularly monitored to assess the effectiveness of the interventions.
Results: The approach led to several improvements in the patient’s health outcomes. Through the integrated care strategy, the patient achieved better adherence to medications, particularly immunosuppressive therapy. The patient’s weight improved, and her overall stability, including kidney function, was maintained after she was weaned off PLEX in 2019. Psychological and nutritional support played a significant role in addressing her anorexia nervosa, and ongoing collaboration between her medical and psychological care teams facilitated her progress.
Conclusion: This case demonstrates the significant impact that eating disorders can have on medical treatment adherence, especially in patients with complex chronic conditions like a kidney transplant. The multidisciplinary approach used in this case proved effective in overcoming barriers to treatment, such as non-adherence to medications and challenges in weight management. The key lessons from this case are applicable to other patients with similar challenges. The findings highlight the need for comprehensive, patient-centered care to optimize long-term outcomes in individuals with complex medical and psychological conditions.