Q: I am a 66 years old male. I had a kidney transplant 12 years ago. My creatine level has been rising progressively since then. From 1.0 mg/dl five years back, it has risen to 1.8 mg/dl now. Does the rise indicate imminent kidney failure? I have no other special symptoms except decreased urination. But urine output increases if I drink a lot of fluids at one time. What are the warning signs of a kidney transplant failure?

A:Gradual impairment of the functioning of the transplanted kidney or allograft over years (4 years in your case) is most commonly caused by an entity called "chronic allograft nephropathy" (lately the name was revised, called "Interstitial fibrosis and tubular atrophy without specific etiology"). It involves injury to all parts of the kidney, diagnosed by tissue biopsy. There are no specific symptoms of this condition except noticing poorly controlled blood pressure and increased urinary losses of protein over period of time.

Unfortunately, there is no specific treatment for it. It involves adjusting the immunosuppressive medications and its dosages (some of them are kidney toxic if administered over a long period of time in excessive dosages), strict control of blood pressure and blood cholesterol if elevated. Further, as part of the evaluation, you would need kidney ultrasound to rule out obstruction, urine studies to check amount of protein leakage in the urine and probable kidney biopsy to rule out late rejection of the transplanted kidney (though obstruction and rejection are unlikely causes of kidney dysfunction at such a later stages of post kidney transplant period).

It is also difficult to prognosticate the chances of your kidney failing in near future without undertaking the kidney biopsy. Meanwhile, you should remain compliant with your immunosuppressive medications along with the measure listed as above with close follow up with your Nephrologist.