Clinical Case Scenario
A 65-year-old patient is 3 weeks post-double lung transplantation. He presents with a rapid rise in serum creatinine (from baseline 0.9 mg/dL to 2.8 mg/dL over 5 days). Urine output remains adequate. His immunosuppression regimen includes tacrolimus (trough level 18 ng/mL), mycophenolate mofetil, and prednisone. In view of decline in post transplant pulmonary function test values, the patient underwent a CT angiogram of thorax. He has also developed a new onset dry cough with lethargy and irritability.
On examination he is conscious, alert. Vital parameters as:
HR: 84/min
BP:128/76 mmHg
RR: 16/min
Temp: 37 C
Chest X-ray shows no acute pathology.
Lactate: 1.4 mmoL/L
Urinalysis shows:
Protein +
Sugar Absent
Ketone Absent
Nitrite Absent
Pus cells 1-2
RBCs Nil
Casts Nil
Crystals Nil
Epithelial cells Absent
What is the MOST likely cause of his acute kidney injury?
