26th June 2023

A 49-year-old woman with a background of end-stage renal failure secondary to IgA nephropathy underwent a renal transplant three years ago.

A 49-year-old woman with a background of end-stage renal failure secondary to IgA nephropathy underwent a renal transplant three years ago. She has had good renal function since, with a postoperative baseline creatinine of 110μmol/L. Her immunosuppressive drugs are mycophenolate mofetil and tacrolimus.

She sees her general practitioner due to troublesome vaginal thrush and is prescribed oral fluconazole. Bloods in routine transplant follow-up clinic a few days later show a creatinine of 180μmol/L. She is very well in herself; the only new clinical finding is a mild tremor of the hands.

What is the most likely cause of the worsening renal function?