A gradual rise over a longer period of time is a sign of chronic rejection. Chronic rejection is also associated with proteinuria. Generally, any high level of creatinine that persists or increases warrants a biopsy. The rise could be a sign of rejection or of the primary kidney disease. Biopsy is protocol for people with normal creatinine levels in some transplant programs.
Rejection can occur without a raise in creatinine levels.
A biopsy of the transplanted kidney is done in 3-month intervals if abnormalities persist. These abnormalities can frequently be controlled with appropriate changes in immunosuppressive medication. Patients on high doses of cyclosporine are at risk for developing cyclosporine toxicity, which is also indicated by a rise in creatinine. Lowering the dosage usually reduces creatinine level. Various infections can occur, such as cytomegalovirus, herpes simplex 1 and 2, fungal, and yeast in otherwise successful transplants.