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1. Determine the cause of deterioration in renal function in renal transplant - pre-renal, intrinsic, post-renal.

2. Early failure - hyper-acute rejection due to pre-formed donour antibodies.

3. Failure within 3 mths - rejection, drug-induced toxicity, infection (CMV or BK virus), & recurrence of disease for which the kidney was transplanted (primary FSGS).

4. Inx - start workup by checking levels of immunosuppressant drugs: cyclosporine, tacrolimus, sirolimus. Screen for CMV and BK virus and obtain renal U/S. If these are normal renal biopsy is indicated.

5. Immunosuppression: Most patients are on "triple therapy" with CNI (or sirolimus), MMF, and a corticosteroid.

6. Urinary tract infections, pneumonia, and sepsis are common events after renal transplant. Patients are given primary prophylaxis against Pneumocystis for 1 year post-transplant and against CMV for 3 months.

7. The main cause of death after kidney transplant is cardiovascular disease.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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