Q: I am a 43 years old kidney patient, and had a kidney transplant. Now after 8 years, the kidney has started rejecting again. My creatinine has increased to 3.25 & urea has risen up to 100. What should I do?

A:There can be many reasons for rising urea and creatinine in a transplant patient. Rejection is one of them. The others could be recurrence of primary disease, uncontrolled hypertension, obstruction vascular disease or chronic allograft nephropathy. It may need detailed investigations including a graft biopsy to delineate various causes of kidney dysfunction. Depending on the cause it could be managed. If it is chronic allograft nephropathy (CAN) then cyclosporine should be reduced and one could add Sirolimus or mycophenolate mofetil.