What is your approach for a kidney transplant patient who develops proteinuria after everolimus initiation?

The management typically should take into consideration the reasons the patient was converted to mTOR inhibitors and whether everolimus is being used de novo versus converted from calcineurin inhibitor. In general, if the patient was not proteinuric and developed heavy proteinuria (> 1 gram per day) on a sirolimus I would recommend switching back to calcineurin inhibitor-based immunosuppression as the proteinuria can be reversible by switching back to calcineurin inhibitors. Again, that should b...