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Renal Impairment

Renal impairment means that your kidneys are not functioning normally. One of the major complications that can follow a liver transplant is a sudden loss of kidney function. This is known as acute renal failure and affects as many as one in four people.

Renal impairment makes it much more difficult for doctors to manage your disease. It may be reversible if doctors can diagnose it early enough, so it is important that problems are identified quickly and properly treated.

What causes renal impairment?

The general effects of immunosuppression can weaken your kidneys. The use of cyclosporin and tacrolimus is known to affect the kidneys by reducing blood flow and causing a type of fibrosis (scarring) to occur.

To treat this and stop kidney function getting worse, doctors will reduce the dosage of CNIs and prescribe other effective but less toxic drug combinations. Immunosuppressants such as sirolimus and mycophenolate work differently to CNIs and do not affect the kidneys to the same degree. Doctors may use these drugs instead of or in combination with a low dosage of CNIs.

While more research needs to be carried out, certain factors can help doctors to predict whether you are likely to progress to chronic kidney disease (CKD). The main ‘predictors’ are:

  • having renal failure in the first three to twelve months following transplantation
  • renal failure before your operation
  • a history of cirrhosis and renal disease before your operation
  • having taken cyclosporin or another CNI medicine and your body reacting to it
  • having hepatitis C before transplantation
  • having diabetes before transplantation
  • high blood pressure (hypertension)
  • your age and sex – CKD occurs more in older recipients and more commonly in women

Other known chronic Kidney disease factors are obesity and smoking

Where such risk factors are known, medical staff will work with you to reduce the chances of renal impairment or minimise the rate of development of chronic renal failure. Your kidney function is tested each time you visit your clinic. Close attention will be given to your glomerular filtration rate (GFR), levels of a protein called creatinine in your blood and evidence of proteinurea (an increase of protein in urine).