You suspect kidney transplant rejection when the patient shows which symptoms?
A. Pain in the incision, general malaise, and hypotension.
B. Pain in the incision, general malaise, and depression.
C. Fever, weight gain, and diminished urine output.
D. Diminished urine output and hypotension.
Correct Answer: C. Fever, weight gain, and diminished urine output.
Symptoms of rejection include fever, rapid weight gain, hypertension, pain over the graft site, peripheral edema, and diminished urine output. Kidney transplantation is the treatment of choice in patients with end-stage renal disease or severe chronic kidney disease as it improves the quality of life and has better survival advantages compared to dialysis. Various factors merit consideration to match the donor kidney with the recipient, as the donor kidney acts as an alloantigen.
Option A: In general, when transplanting tissue or cells from a genetically different donor to the graft recipient, the alloantigen of the donor induces an immune response in the recipient against the graft. This response can destroy the graft if not controlled. The whole process is called allograft rejection.
Option B: Most patients who have acute rejection episodes are asymptomatic and have abnormal allograft dysfunction evidence from the routine blood workups; when there is a sudden rise of serum creatinine to more than 25% of the baseline value, the clinicians should suspect allograft rejection.
Option D: Even when the creatinine is not trending down as expected in the early post-transplant phase, the possibility of rejection should be a consideration. Any new-onset or worsening proteinuria and new-onset or worsening hypertension should raise the suspicion for rejection.
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