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
  • ┬áCheck for pyrexia
  • Culture urine, PD fluid
  • Consider CMV PCR
  • Get Tacro / CyA level
  • Consider:
    • USS to exclude mechanical/vascular problem
    • Duplex
    • Renal biopsy