After treating rejection, a falling creatinine is reassuring but does not confirm that inflammation has resolved, and a static creatinine does not prove failure.
Follow-up biopsy, where available, answers the question directly. Donor-specific antibody testing and adherence review belong in the same assessment.
- Do not rely on creatinine alone to judge response to rejection treatment.
- Consider a follow-up biopsy after treating T cell-mediated rejection.
- Review adherence to immunosuppression and drug levels at every rejection episode.
- Check donor-specific antibodies when rejection recurs or fails to respond.
Why it matters
A kidney can look better on bloods while the inflammation that destroys grafts continues.
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