Daily Bolus of LR: Renal Dysfunction in Renal Transplant Patients

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August 23, 2011 by dailybolusoflr

Renal Dysfunction in Renal Transplant Patients


·         The kidney is the most commonly transplanted organ in the US.

·         The most common time for acute rejection is in the 1st 4 weeks after transplantation, but acute rejection can occur at any time.  This diagnosis is made by renal biopsy. 

·         Evidence of renal dysfunction in post-transplant patients should always raise suspicion for rejection, but reversible causes should be sought and corrected.

·         Evaluation in the ED should include:

o   UA can help diagnose infection; red cell casts or protein can point to glomerulonephrosis or vasculitis

o   Ultrasound should be performed to evaluate for renal artery or vein thrombosis or renal artery stenosis.  It can also find hydronephrosis from obstruction.

o   BUN/Creatinine- can point to hypovolemia or other pre-renal states.  Although it is important to note that an elevated BUN/creatinine ratio can also be seen in acute rejection states and in nephrotoxic states (most commonly from cyclosporine and tacrolimus)

o   History- focus on typical infection questions, new medications that could have decreased effectiveness of cyclosporine/tacrolimus/sirolimus levels (some common: rifampin, phenobarbital, phenytoin, nafcillin, octreotide, valproic acid, St. Johns Wart), new nephrotoxic drugs (some common: gentamicin, vancomycin, bactrim, cimetadine, ranitidine, ketoconazole),  urine output, suspicion for dehydration

o   Exam-focus on site of transplanted kidney (is it tender or enlarged; site infected in recent surgery?); do they appear systemically ill (any systemic infection can lead to renal dysfunction)



Ref: Roberts and Hedges 5th edition (chapter 118)


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