skip to content

Management of altered graft function

An increase in creatinine may be caused by a number of processes, but common causes are:

  • Rejection
  • Infection, e.g. urine, CM
  • Tacrolimus / Ciclosporin toxicity
  • Altered fluid balance

Less common causes are:

  • Vascular catastrophe
  • Mechanical problem - urinary obstruction (less likely if ureteric stent present), lymphocele

A patient whose creatinine has increased requires careful assessment, as often the classical signs of rejection (pyrexia, tender graft) are not present with current immunosuppressive agents.

  • Review patient's fluid status and fluid balance charts;
  • Check FBC
  • Note particular decrease in urine volumes, tender graft
  •  Check for pyrexia
  • Culture urine, PD fluid
  • Consider CMV PCR
  • Get Tacro / CyA level
  • Consider:
    • USS to exclude mechanical/vascular problem.
    • Duplex
    • Renal biopsy.

Licensed under a Creative Commons LicenseCreative Commons Attribution 4.0 International License.

K   Designed by beesign wien

This page last modified 07.10.2013 13:54 by Emma Farrell. edren and edrep are produced by the Renal Unit at the Royal Infirmary of Edinburgh and the University of Edinburgh. CAUTIONS and Contact us.