Brief Answer:
mild graft dysfinction

Detailed Answer:
Hello

Thanks for the query

From the excel sheet you have uploaded it looks like you have a mild graft dysfunction.
Here is how you should go about it.

1. Please get tacrolimus ( pangraf) level done. Increased tacrolimus level can cause graft dysfuntion
2. Get a urine routine and a 24 hour urine protein done to know if there is any recurrence of your native kidney disease
3. Please let me know the biopsy report so that I can assess what is happening
4. Please make sure to take the tablets on time, and make sure your hypertension is under good control

I need more info as well
1. What was the basic kidney disease before transplant?
2. Who was the donor? Age? Was any induction given before surgery
3. Was your surgery uneventful?

Please get back to me, I am awaiting your reply

Regards

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Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back with the details. I have gone through the reports attached by you

Here are my recommendations to you

1. Your proteinuria is 1.8g/day, i recommend that you increase your ACE/ARB to the highest tolerable dose. Proteinuria is directly toxic to the kidneys
2. I recommend strict control of hypertension and also make sure that your Tacrolimus level is within normal range
3. There is no known effective treatment for transplant glomerulopathy except proper control of hypertension and use of ACE/ARB
4. Transplant glomerulopathy is related to HLA class II antigens, so I recommend you to get a Donor specific antibody done to rule out rejection

I hope I was of help, please get back to me for any further queries

Regards

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Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back

I am extremely sorry for using medical terms, I keep forgetting to use simple terminology. Let me try and explain things in a better way

1. ACE/ARB is a group of anti hypertensives which act against renin angiotensin system. Examples are telemesartan, enalapril, etc. They help reduce proteinuria and also protect the kidneys. Patients on ACE/ARB are known to have a longer kidney graft survival. I usually prescribe Losartan twice daily, please dont take this medical without supervision

2. DSA is a test, you will have to take your donor and give it for testing along with yours. They will cross check if there are any antibodies which might be causing rejection

3. You must be on ACE/ARB please speak to your nephrologist in your next visit

Regards

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