Drug ineffective: case reportA 69-year-old woman exhibited ineffectiveness with fenoldopam, while being treated for hypertension [dosage and route not stated].The woman, who had various comorbidities, suffering from end stage renal disease (ESRD) due to chronic kidney disease and she was on a 3-week haemodialysis treatment for 10 years. In December 2018, she underwent kidney transplant from a deceased heart beating donor. The surgical procedure was uneventful. The allograft presented a single artery and vein. With an end-toside technique vascular anastomosis with external iliac vessels was carried out. The arterial vessels of donor and recipient were both affected by atherosclerotic plaques that did not prevent surgery. She received induction immunosuppressant therapy with basiliximab, and maintenance immunosuppressant therapy with unspecified calcineurin inhibitors, prednisone and mycophenolate mofetil. Her postoperative course was complicated by delayed graft function. She required dialysis on every 2 days starting from the postoperative day (POD) 2 due to oliguria and high levels of serum creatinine. She was not able to discontinue dialysis and her renal function was stabilised. Postoperative US excluded fluid collections or ureteric obstruction. Doppler US showed a fair blood supply and modest increase in the peak systolic velocity (280 cm/s) on the main renal artery. On POD day 5, parvus-tardus waveform was detectable in periferic graft arteries with low resistive index. Despite the intake of nifedipine and thioctic-acid [alfa lithic] worsening of the systolic pressure was observed. However, fenoldopam was ineffective to improve blood pressure (lack of efficacy) facilitating renal function recovery. On POD 7, she underwent an angio-CT scan; the graft appeared well perfused, but the examination showed a mild stenosis of the main renal artery (TRAS). The stenosis was localised at the anastomosis. On POD 8, she underwent an arteriography along with angioplasty. Angiography showed that moderate stenosis did not persisted. Repeatedly pressure gradient measured and the mean pressure was 101 mm Hg, and distal pressure was 96 mm Hg, with a resting Pd/Pa ratio of 0.95, and the peak-to-peak systolic pressure gradient was 20 mm Hg. This was thought to be acceptable as the endpoint of TRAS-endovascular treatment. The procedure was technically successful. US examination showed decreased peak systolic velocity. After the endovascular procedure, improved blood pression control was achieved, but there was no significant enhancement in renal function was noted. She remained oliguric and dependent on haemodialysis. On POD 15, she underwent a percutaneous needle biopsy and it showed normal renal parenchyma and excluded acute rejection. She was discharged and placed on chronic haemodialysis treatment while continuing the intake of immunosuppressive therapy and carrying out frequent follow-ups at our center. Between POD 90 and 130, an improvement was observed in serum creatinine values and urinary output with an expansion of int...
