Management of altered graft function
An increase in creatinine may be caused by a number of processes, but common causes are:
- 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
- USS to exclude mechanical/vascular problem.
- Renal biopsy.