Clinical signs of rejection after renal transplant include the following except?

Appeared in: VSSC Nursing Officer - 2021

Explanation

Increased urinary output (polyuria) is not a sign of renal transplant rejection; it indicates the opposite of graft failure.
Rejection involves an immune attack on the kidney, impairing its ability to filter blood and produce urine, which leads to a decrease in urine output (oliguria).
While a well-functioning new kidney might initially produce a large amount of urine (post-transplant diuresis), this is different from the signs of active rejection.
A sudden and significant drop in urine volume is a hallmark sign of acute rejection that requires immediate medical attention.

Option A: Fever is a common systemic sign of rejection, reflecting the body's inflammatory response to the foreign kidney graft.
Option B: Tenderness over the transplant site is a classic local sign of rejection, caused by inflammation and swelling of the graft as the immune system attacks it.
Option C: Decreased urinary output (oliguria) is a primary and critical indicator of acute renal rejection, as it directly reflects the kidney's failing function.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Signs and symptoms of renal transplant rejection in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Nurses are at the forefront of detecting transplant rejection. Meticulous monitoring of urine output, vital signs, daily weights, and the graft site is a critical nursing responsibility.
Prompt reporting of any suspected signs of rejection (fever, graft tenderness, oliguria, rising creatinine) to the transplant team is essential to initiate timely treatment and preserve graft function.
Patient education on immunosuppressant adherence is a key nursing role. Non-adherence is a major cause of late acute and chronic rejection.

How to Approach the Question

First, identify the core subject of the question, which is the clinical signs of renal transplant rejection.
Next, notice the critical keyword 'except'. This tells you that three of the options are true signs of rejection, and your task is to find the one that is not.
Think about the pathophysiology of rejection: the immune system attacks the kidney, causing it to fail. A failing kidney cannot do its job of producing urine.
Evaluate each option: Does this sign indicate kidney failure? Fever (inflammation) = Yes. Tenderness (inflammation) = Yes. Decreased urine output (failure to filter) = Yes.
The option 'Increased urinary output' suggests the kidney is working, perhaps even over-working, which is contrary to the state of rejection. This makes it the outlier and the correct answer.

Concept Tested & Keywords

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