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CHAPTER 9








                        CREATININE LEVELS





               very time you come to the clinic you will have
              a blood test which will measure, amongst
        Eother things, your serum creatinine. A
        creatinine level gives a very good idea of how well
        your kidney is working. A very well functioning renal
        transplant should have a serum creatinine of around
        100 to 120 umol/L.
           If your creatinine level starts rising, your doctor
        may order some investigations to establish what is
        the reason for this. There are a number of reasons
        for a rise in creatinine including:

                                                     Problem with the flow of urine from the bladder or
         ●A mechanical problem with the
                                                     kidney
            flow of urine from the bladder or
                                                        Clearly, for the donor kidney to function well, the urine has
            kidney.
                                                     to be able to flow out of the body. Sometimes, after
         ●High Prograf or Cyclosporine level.        transplant surgery, a blockage in urine flow can occur. This

         ●Acute Transplant rejection.                may arise as a result of narrowing in the tube that joins the
         ●Chronic Transplant Rejection.              kidney to the bladder called the ureter. The diagnosis of
         ●A viral infection called Polyoma           narrowing of the transplant ureter (ureteric stenosis) will
            virus.                                   usually be made by ultrasound scan of the kidney. If
         ●Recurrence of original disease in          Transplant Ureteric Stenosis develops, it will usually be
            the transplanted kidney.                 treated by inserting a nephrostomy tube into the kidney. A
                                                     nephrostomy is a drainage tube that is inserted directly into
         ●Transplant artery narrowing
                                                     the kidney and allows the urine to drain into a bag. A
            (stenosis).
                                                     subsequent operation will usually be required to bypass the
                                                                     blockage in the transplant ureter.
                                                Nephrostomy Tube
                                                                        It is also possible that the reason the
                                                                     transplant is not draining properly is because
                                                                     a    lymphocoele     has    developed.    A
                                                                     lymphocoele is a collection of fluid, which
                                                                     can develop around the transplant and
                                                                     compress the ureter, stopping the urine from
                                                                     flowing properly. If this problem develops it
                                                                     will require a small operation to make this
                                                                     fluid drain internally.
                                                                        In men, enlargement of the prostate gland
                                                                     can affect bladder emptying. This can be
                                                                     treated medically or surgically.



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