Clinical Case Scenanio
Jonathan Hayes, a 50-year-old kidney transplant recipient, presented with a gradual decline in graft function one-year post-transplant. His creatinine had risen from 1.72 mg/dL to 3.75 mg/dl with proteinuria, with a urea level of 90 mg/dL, despite unremarkable renal ultrasound findings. He remained on tacrolimus and mycophenolate mofetil, with a tacrolimus trough level of 6.4 ng/mL. Laboratory tests showed an elevated C-Reactive Protein of 28.7 mg/dL, but no obvious source of infection was identified on imaging or urinalysis, and CMV-PCR was negative. The abdominal CT-angiogram showed the following:
What can be the cause of his worsening graft function?
