My father 65yrs old who had udergone renal trasplant 10yrs back.he is taking cyclosphorine.for the past years everything was normal.but now his creatinine is increasing gradually and reached 4.2.Ultrasound report / cyclosphorine level is normal.now docor recommended for biopsy.Is it an alarming situation?what does this indicate? How the normal can be maintained?
A detailed history, clinical examination and investigations are very important for diagnosing the cause of his symptoms, Is there any history of viral illness? Vomting and diarrhea, decreased intake of fluids can lead to hypovolaemia and high creatinine levels. Virus induced interstitial nephritis could be other possibility. .Another possibility though rare after so many years of transplant is development of a lymphocele.It is a collection of lymph around the renal allograft that may occur due to disruption of the lymphatic system draining the leg during the time of transplantation. Urologic complication, transplant rejection, infection and drug toxicity needs to be ruled out. Several tests such as ultrasound and blood work-up needs to be done. A gradual rise of creatinine over a longer period of time is a sign of chronic rejection. This is also associated with proteinuria. Biopsy may also be indicated. Do consult your doctor. I hope it helps.
Take care and regards!
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