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Tacrolimus zigzagging and creatinine gradual increase: any feedback?
Hello All,
I had my transplant a bit over 7 months. I had the anti-rejection meds adjusted several times and my WBC finally is back to normal. But Tacrulimus has and still zigzagging from 6 to above 9. Y level should be 6-8. High tacrulimus level is toxic. My creatinine level has been good so far between the normal range but gradually in last few month started to get closer to the upper limit 1.0 and kept increasing to 1.1 and two days ago to 1.2. I had my new kidney biopsy at the 4 month after surgery at Mayo Clinic (my surgery hospital) and tje pathology report and the Mayo team nephrologist assured that there is no sign of early rejection. That was 3 months ago. I sent a message on portal expressing my concern about the trend of creatinine increasing, I am really concerned if this could be a sign for a serious issue. My current TAC (tacrulimus) dose is 3 at 8am and 2at 8pm. Nothing else was warning in blood test except the creatinine level.
I am sure it means something, kidney stress from TAC fluctuations or dehydration which I don’t think so as I pay attention and following how much to drink around 1.5 litters Dailey.
I read some members here they drink water before thy go for blood test , doesn’t this hide the true level? Just asking.
Thach’s for reading my message.
@futureckd
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My doctors also told me to drink water before my blood tests. I would be fasting before the test so fasting for 12 hours can affect your creatinine test if you haven’t had any water.
It sounds like you are doing well. I wouldn't be overly concerned about the creatinine at 1.2 as it's actually a very good level. The most important thing to get accurate creatinine levels is to hydrate which it sounds like you are. In the morning before labs, I will drink 8 to 12 ounces of water. If you are hydrated and your creatinine goes up at least you know that it's not from being dehydrated. An increase from 1.1 to 1.2 in my opinion isn't something to be concerned about. Tacrolimus will fluctuate and that's pretty normal especially so early after a transplant. Don't be surprised if they lower your dose as time goes on and at some point, lower your range. The four-month biopsy would also show if the Tacrolimus was toxic to your kidney and they would have adjusted if it would have been.
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1 ReactionI have been on tacrolimus since my transplant 6 years ago. My dose is 1 and 1. I think my first couple of years after thee transplant my creatine level fluctuated quite a bit. It sounds like you are doing really well.
@stolson1
Thank you all for the assurance. I believe in patient experience. I will keep the hydration as advised. I received a response that I should be consistent taking Tacrolimus with food or without food morning and evening. I was not taking it with food in the morning and sometimes in the evening. I started being consistent and take it with food in both everyday. I read about it also and saw the same information. I am vegan so my food is light anyway. But it seems that tacrulimus is very sensitive to food also.
Thanks again!
Hello all,
I consulted with the nephrologist and he balanced the morning dose with the evening dose, so instead of 3 tablets in the morning and 2 in the evening, we made it 2.5 morning and 2.5evrning. This plan is for 6 weeks to see the new pattern, if it is zigzagging still he will switch me to another form of tacrulimus.
Zigzagging put stress on the kidney as far as I understood.
Also I make sure now to be consistent with food before or after the meds; I decided to take the meds with food.
At the end the goal is to stabilize tacrulimus level in blood.
Thanks