Renal Failure Post-Transplant - Approach

• In addition to usual players, should consider the following:

  • Acute rejection: most common finding is sterile pyuria, with graft tenderness, F/C/NS uncommon
  • Recurrent underlying kidney disease
  • Infection:
  • Pyelonephritis: patients are often less symptomatic than general population, due to immunosuppression and potential anti-bacterial effects of PCP prophylaxis
    • BK virus: polyoma virus with GU tropism – causes hematuria, pyuria, atypical cells, and can diagnose via PCR
    • Calcineurin-inhibitor toxicity: secondary to vasoconstriction of afferent arteriole, which leads to a reduction in GFR – can thus give pre-renal picture on urine electrolytes

• In general, it is important to remember that given impaired autoregulation, renal transplant patients behave like CKD patients, and are thus much more sensitive to perturbations in BP and intravascular volume

(Christopher Woo MD, 1/11/11)