Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for follow-up of renal transplant dysfunction characterized by a progressive rise in serum creatinine and new-onset proteinuria. History significant for presence of donor-specific antibodies (DSA). No acute infectious symptoms reported. Current immunosuppression regimen reviewed for adherence.
Clinical Examination Findings
Patient is hemodynamically stable, afebrile. Physical exam reveals mild peripheral edema (1+). Transplant kidney site is non-tender, no palpable masses or bruits. No signs of systemic fluid overload or uremic manifestations.
Treatment Protocol
Management plan includes optimization of immunosuppression (calcineurin inhibitor trough levels, mycophenolate dosing). Consideration for IVIG, plasmapheresis, or rituximab based on DSA titer and biopsy severity. Strict blood pressure control with ACE inhibitors/ARBs for antiproteinuric effect.