skip to content

Management of altered graft function

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

  • Acute rejection
  • Infection, e.g. urine
  • Tacrolimus toxicity
  • Altered fluid balance

Less common causes are:

  • Vascular catastrophe
  • Mechanical problem - urinary obstruction (less likely if ureteric stent present), lymphocoele, urine leak.

A patient whose creatinine has increased requires careful assessment, as usually 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


Management of delayed graft function << | Transplant Handbook | >> Renal transplant biopsy

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

K   Designed by beesign wien

This page last modified 08.02.2018 09:24 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.