Kidney Biopsy Complication

My creatinine still goes up and down between 1.4 and 1.9. That just seems to be normal for me. Since the rejection test was negative, there are no plans for further tests.

Both of my transplants are from deceased donors. Creatinine levels for my transplant in 1994 were always above 2.0. But it kept working for 25 years.

@tjdog 😊
Wow, you have years of transplant experience, for sure!
Twenty five years from your first kidney is a wonderful run...(Maybe I am panicking prematurely.)
Thank you so much for telling me about your experience with fluctuating creatinine levels tj.
I need your counsel about something else... After all these years, what is your secret for staying resilient, calm and emotionally stable through each transplant challenge? How do you stay calm and steady through it all?

I've only had the protocol Post Kidney Biopsies. I think mine were years 1,3,5,10. This might be different now, but that was my only experience with kidney biopsy, This conversation caught my interest and I was curious about the information that @tjdog shared. So I did a quick investigation and this is what I found and want to add to this conversation. I was happy to see this because I am past the 10 year protocol, and was wondering "what if...?"

There is a different purpose in Prospera and kidney biopsy.
- Prospera™ ( link shared above by @tjdog) is for Kidney Transplant Assessment. It is covered by Medicare. It is a transplant rejection assessment test that uses a simple blood draw to evaluate the risk of rejection of a transplanted kidney.

- Kidney Biopsy - from the Mayo Clinic Health Library Tests and procedures.
A kidney biopsy is performed to diagnose, help develop treatment, check progression and extent of damage, evaluate if treatment is working. and "Monitor the health of a transplanted kidney or find out why a transplanted kidney isn't working properly".
@hello1234, In the section on Risks, I read this and thought of you. "Arteriovenous fistula. If the biopsy needle accidentally damages the walls of a nearby artery and vein, an abnormal connection (fistula) can form between the two blood vessels. This type of fistula usually causes no symptoms and closes on its own."
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https://www.mayoclinic.org/tests-procedures/kidney-biopsy/about/pac-20394494
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I also want to tag - @gingerw, @jennifer0726

I think some friends and family would question my emotional stability 😀. Seriously though, I think it’s helped to know since I was 17, that kidney failure was in my future. My family has Alport Syndrome. I had my first transplant at 42 and both of my nephews needed kidney transplants in their early 40’s. They’re both doing well.
When it’s not a shock, I think it’s easier to cope with.

@rosemarya 😊
Thank you for the excellent information! When I was initially told that the biopsy caused an av fistula within the kidney, I was comforted to hear that it normally causes no symptoms and normally closes in 2 years by itself.
Unfortunately, my av fistula is now starting to cause the kidney function to decrease and also now appears to be getting larger. It will need embolization.
I am excited to hear that there is now a non-invasive blood test available to assess rejection. Moving forward, that will be a terrific diagnostic tool!
Thank you again for doing all that research Rosemary.... Very helpful!

Hi there,

My husband is in his 2nd year of kidney transplant. I believe he participated in this Prospera research test between his 4 month and 1 year checkup. Mayo Az set everything up and Natera sent a nurse to our home(we live in Calif) to draw blood but I don't believe we ever heard about the results. For 2nd year checkup his transplant team says he has the option of doing a kidney biopsy(needs to be done on site) or can possibly do Prospera. The transplant neph did say though if it were him he would do a biopsy for the 2nd year checkup because it would screen for early detection of early rejection. He says the kideny biopsy would be a more accurate measure of any rejections but of course there are possible risks!!
The third year will just be lab draw which can be done remotely and would just be a video visit.

@hello1234
I haven't been reading the Mayo Clinic Connect posts lately but am glad I looked at it tonight. I'm so sorry you're having to go thru this. Even though your creatinine is a little elevated it's still not high, still in the "normal range". My husband's creatinine baseline is higher than 1.1 and his is considered good because, as the neph explains it, you really need to divide by 2 since there is only 1 transplanted kidney. I'm not sure I'm doing a good job explaining but the bottom line is your creatinine is not alarmingly high but of course the sooner you get this resolved the better. With the treatment Mayo is planning I hope that it will take care of the embolism in the fistula. Let's be optimistic and hope that your beautiful transplanted kidney can be saved and last for as long as your on this earth!! I have only heard of embolism in the fistula of the arm as in dialysis.
Because there are risks in doing an ultrasound aided kidney biopsy, I am struggling to decide whether my hubby should do the 2nd year kidney biopsy. This would be his 3rd one and I'm debating whether it's a good idea to poke his transplanted kidney that many times! His transplant nephrologist seems to think it's a good idea because of early detection or rejection can be seen and treated more easily/successfully. He does recommend it for the 2nd year but it is optional and we can decide. After hearing what has happened to you, I'm not so sure this is a good idea anymore!
Question: Did your team know about the complication after your 4 month post transplant biopsy, and they expected the fistula to resolve itself after 3 years? So it took a while for your creatinine to elevate?

Hi @caretakermom 😊
It's so great to hear from you! I am so happy you logged on today too so we can catch up!
Yes, most of the time if these av fistulas form in the kidney as a complication after biopsy, they will spontaneously heal within two years (and not cause symptoms). My fistula is not.
Regarding your husband. Your husband, like me, has suffered with the opposite of rejection.
The immune suppression meds were running too high and allowing recurring CMV infection.
I had CMV, then the immune suppression was lowered in half, then I had BK and it was lowered in half again, even now I have 7 million BK urine so the "lowered" meds are staying as my new dosage.
Infection normally occurs when the immune suppression dosage is too high. Rejection normally happens when the immune suppression is too low.
My personal recommendation (not a doctor) is to avoid the invasive test and have the blood test first. If the blood test result is concerning, then go for the biopsy.

HI @hello1234

So you think the slight elevation of creatinine is due to the lower immune suppressive dosage, and not the AV fistula complication that is present in your transplanted kidney? What can they do to resolve BK virus that is present in your urine? I asked about BK at 1 year checkup and the transplant neph says BK , like CMV, occurs usually during the 1st year of transplant. He says BK/CMV can happen later but very very seldom so he told us not to worry too much about it. But I'll definitely not ignore it and be vigilant.
May I ask how many kidney biopsy protocols have you had post transplant? My hubby's has had 2 (at 4 month and 1 year checkup) and Mayo Az's annual checkup includes kidney biopsy up to the 2 year checkup, however, some of the patients I know only did 1 or 2 max because of COVID when they limited in-person visitation. At 3 year it will just be blood draw labs which can be done locally. After that they do not require any more checkup, unless you experience complications.
Mayo Az recommends the biopsy for all of their transplant patients up to 2 year, because it will help detect early rejections. The transplant neph says it is more reliable than the Prospera test which detects current rejecton. We will discuss with our local neph to get his recommedation(he will probably recommend it because low risk of injury). It's such a difficult decision whether to do the biopsy because it does cary risks of injury and the Prospera lab will not show EARLY rejections which is the reason transplant neph prefers biopsy! There are definitely pros and cons, like everything else in life I'm afraid! I have always understood that risks are real though small in kidney biopsy, but the impact is greater when you actually know someone who is going thru it. Thank you for your advice and bringing this issue to our attention. Please keep us posted on how your treatment goes!

Hi @caretakermom 😊
Sorry for any confusion. It is the av fistula that is probably affecting the creatinine, not the lower immune suppression.
I had two biopsies too. One at 4 months and one at one year. Please keep me posted on what your local nephrologist recommends. I will keep you posted on my treatment!