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A 30-year-old woman with diabetic nephropathy received a cadaveric renal allograft. On the third post-operative day her serum creatinine concentration was 160 mol/L (1.8 mg/dL). She is being treated with cyclosporine and prednisone. On the sixth postoperative day she experiences a decrease in urine output from 1500 mL/d to 1000 mL/d; the serum creatinine concentration increases to 194 mol/L (2.2 mg/dL). Her blood pressure remains stable at 170/90 mmHg, and her temperature is 37.2°C (99°F). The best initial step in management would be to

A) decrease the dose of cyclosporine
B) obtain ultrasonography of the renal allograft
C) obtain a biopsy of the renal allograft
D) administer pulsed steroid therapy
E) administer an intravenous bolus of furosemide






i think it should be ultrasound , maybe this is due to obstruction somewhere , the question asks best iINITIAL step , if US fails to show a cause , we can go to biopsy


u r right....i checked washington manual and before biopsy we have to u/s first to check if there is obstruction or leakage


The answer is B.
In the first week after renal transplantation the differential diagnosis of graft dysfunction includes early rejection, hypovolemia, cyclosporine intoxication, acute tubular necrosis, urinary obstruction, and renal artery thrombosis. Cyclosporine can mask many of the classic signs of rejection, such as fever and graft tenderness; renal biopsy often is needed to make the diagnosis. However, renal ultrasonography should precede any manipulation to rule out mechanical outflow obstruction, as it should in any patient with acute deterioration of renal function.

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