Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute rise in serum creatinine following recent dose adjustment or initiation of interacting medications. Reports no symptoms of obstruction or systemic infection. Tacrolimus/Cyclosporine trough levels are supratherapeutic. No history of recent hypotension or volume depletion.
Clinical Examination Findings
Patient appears euvolemic, no peripheral edema. Blood pressure is elevated compared to baseline, consistent with CNI-induced vasoconstriction. Mucous membranes moist, no signs of systemic inflammatory response syndrome (SIRS).
Treatment Protocol
Immediate dose reduction or temporary cessation of CNI therapy. Optimization of intravascular volume status. Review of medication list to identify CYP3A4 inhibitors. Frequent monitoring of serum creatinine, electrolytes, and trough drug levels.