{"id":1543,"date":"2018-09-12T11:32:52","date_gmt":"2018-09-12T11:32:52","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=1543"},"modified":"2025-03-25T16:36:09","modified_gmt":"2025-03-25T16:36:09","slug":"management-of-altered-graft-function","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/management-of-altered-graft-function\/","title":{"rendered":"Management of altered graft function"},"content":{"rendered":"<p><strong><span style=\"color: #993300;\">An increase in creatinine may be caused by a number of processes, but common causes are:<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Acute rejection<\/li>\n<li>Infection, e.g. urine<\/li>\n<li>Tacrolimus toxicity<\/li>\n<li>Altered fluid balance<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">Less common causes are:<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Vascular catastrophe<\/li>\n<li>Mechanical problem &#8211; urinary obstruction (less likely if ureteric stent present), lymphocoele, urine leak.<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">A patient whose creatinine has increased requires careful assessment, as usually the &#8216;classical&#8217; signs of rejection (pyrexia, tender graft) are not present with current immunosuppressive agents.<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Review patient&#8217;s fluid status and fluid balance charts;<\/li>\n<li>Check FBC<\/li>\n<li>Note particular decrease in urine volumes, tender graft<\/li>\n<li>\u00a0Check for pyrexia<\/li>\n<li>Culture urine, PD fluid<\/li>\n<li>Consider CMV PCR<\/li>\n<li>Get Tacro \/ CyA level<\/li>\n<li>Consider:\n<ul style=\"list-style-type: disc;\">\n<li>USS to exclude mechanical\/vascular problem<\/li>\n<li>Duplex<\/li>\n<li>Renal biopsy<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p data-cke-temp=\"1\" data-cke-filler-webkit=\"end\">\n","protected":false},"excerpt":{"rendered":"<p>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 &#8211; urinary obstruction (less likely if ureteric stent present), lymphocoele, urine leak. A patient whose creatinine\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/management-of-altered-graft-function\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":1453,"menu_order":196,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-1543","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1543","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=1543"}],"version-history":[{"count":3,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1543\/revisions"}],"predecessor-version":[{"id":3046,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1543\/revisions\/3046"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1453"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=1543"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}