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Suggest Treatment For Kidney Transplant Graft Dysfunction

Posted on Sat, 24 May 2014

Question: Dear sir, I am XXXXXXX , age 29 yr, had Kidney transplant before 7 months, Now my creat is 6 & Hb is 7.4, platelets - 135000, Urea -112 . i did thymo globulin course in early phase when my creat is 2.1 but no use. After that cd 4 test, Tac level test, Biopsy . Now Bk virus test is going on. After all im not getting results. i have fear that i will lost my transplanted kidney, so i need your help sir. As i am wondering for expert who is going to help me. what is your suggestion sir please sir

Answered by Dr. Ravi Bansal (2 days later)

Brief Answer:
Post transplant graft dysfunction

Detailed Answer:

Hi R XXXXXXX
I have gone through your reports. You have graft dysfunction but as per your biopsy kidney, does not appear to be so bad, as to be lost completely.

There are components of rejection as well as ATN. I will be interested in knowing the BK Virus and CMV virus report, Tacrolimus levels and Ultrasound dopplar findings.

Serum Creatinine should be followed alternate day and over one week see the trend.

In transplantation full assessment of the patient is necessary to make treatment decisions. I think your treating nephrologist is the best person to follow the patient . in case you want 2nd opinion you can bring the patient to me at PSRI HOspital, New Delhi. I will need at least a 5 day observation period in hospital.

serum creatinine six is actually very high. If patient has vomitings he may need dialysis also.

Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (36 minutes later)

Thanks sir,
very soon i get BK virus report, i will send you Tacrolimus level report also.
Now patient having vomiting from last 4-5 days , what kind of diet and precaution you should suggest to him.
If BK virus test is positive then the problem will become serious or treatable.

Answered by Dr. Ravi Bansal (18 minutes later)

Brief Answer:
graft dysfunction

Detailed Answer:

patient should not have juice or fruits. rest vegetarian diet he can have.

If bk virus is positive then steps are to be taken to control it. If vomitings are associated high high serum creatinine better is to start dialysis to control the symptoms, temporarily till we are diagnosing the problem.

Please do not get tense as it will not solve the problem.

best wishes

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ravi Bansal (52 minutes later)

if once we start dialysis then it will become compulsory or we stop after some time. Also Dr told me that we already given a high dose of medicine to patient like Thymoglobulin, so more medication become limitation for us. so i fill that we have less options for medicinal treatment. Is it so ?

Answered by Dr. Ravi Bansal (24 hours later)

Brief Answer:
graft dysfunction

Detailed Answer:

Dialysis is a need based therapy. You eat food when you get hungry. why do we eat food and waste money in buying food --- it is to fulfill the need of the body. Similarly kidney is a vital organ of the body and we need it to survive. If it stops working then we use dialysis ( Plastic kidney). So we can survive . If the kidney function improves patient will not need dialysis but if doesn't improve then dialysis is needed. The next dialysis is not done because the dialysis has been started it is done because the kidney is still not working

There are other treatment for acute rejection, but the biopsy does not much of cellular rejection to cause so high creatinine.

We need to follow the patient and consider possibility of antibody mediated rejection or associated ATN.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ravi Bansal (23 minutes later)

Sir I have upload BK virus test reports which are normal. also HLA, Tac level reports and biopsy reports earlier Tymoglobulin treatment & very 1st biopsy report .

Answered by Dr. Ravi Bansal (45 hours later)

Brief Answer:
graft dysfunction

Detailed Answer:
Hi,

Viruses are negative and also DSA is negative.

I could not find the tac level report in the attachments.

possibilities of mild ongoing rejection are there or associated ATN. I think we should observe serum creatinine serially over next 2 weeks.

best wishes.

Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar