Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for follow-up of renal allograft dysfunction. History significant for long-term CNI therapy (Tacrolimus/Cyclosporine). Clinical presentation includes insidious rise in serum creatinine, new-onset or worsening hypertension, and absence of acute rejection symptoms (e.g., fever, graft tenderness). No history of recent nephrotoxic insults or obstructive uropathy.
Clinical Examination Findings
Physical exam reveals a stable renal transplant recipient. Graft site is non-tender, no palpable masses. Blood pressure is elevated (BP: [Value]). Peripheral edema is [Present/Absent]. General appearance is consistent with chronic renal insufficiency.
Treatment Protocol
Management plan: 1. Optimization of CNI trough levels to the lowest therapeutic range. 2. Consider conversion to alternative immunosuppression (e.g., mTOR inhibitors) if clinically indicated. 3. Aggressive blood pressure control with ACE inhibitors or ARBs. 4. Monitor renal function (eGFR) and proteinuria (UPCR) closely.