Post-transplant hypertension is common, often exacerbated by immunosuppressive medications, particularly calcineurin inhibitors like tacrolimus. Tacrolimus can cause afferent arteriolar vasoconstriction, leading to hypertension and a decrease in GFR. Dihydropyridine calcium channel blockers, such as amlodipine, are the preferred first-line agents as they cause vasodilation of the afferent arteriole, directly counteracting this effect and potentially improving allograft blood flow. ACE inhibitors or ARBs may cause an acute rise in creatinine and hyperkalemia in this setting. Thiazide diuretics are less effective with a reduced GFR and can worsen electrolyte abnormalities associated with tacrolimus. Beta-blockers are not considered first-line agents for this condition.

This patient's presentation is classic for peritonitis, a common and serious complication of peritoneal dialysis. The diagnosis is confirmed by cloudy effluent and a fluid WBC count >100/μL with >50% neutrophils. The standard of care is to initiate empiric intraperitoneal (IP) antibiotics immediately after diagnosis. IP administration achieves high local concentrations and is more effective than intravenous (IV) administration for uncomplicated PD peritonitis. Catheter removal is reserved for severe, refractory, or fungal peritonitis. An abdominal CT scan is not necessary for the initial diagnosis if the clinical picture is clear.

This patient has BK virus-associated nephropathy (BKVAN), a significant cause of allograft dysfunction. The cornerstone of management is a reduction in overall immunosuppression to allow the host immune system to clear the virus. This is typically achieved by first reducing or discontinuing the antimetabolite agent (mycophenolate mofetil or azathioprine). Increasing immunosuppression would worsen the viral replication. Antiviral agents like cidofovir have significant toxicity and are reserved for severe cases unresponsive to immunosuppression reduction. Switching to sirolimus has been studied but is not the standard initial step.

This patient's AVF shows signs of non-maturation. A mature fistula should be easily palpable, have a continuous, low-pitched bruit, and a palpable thrill. By 8-12 weeks, the fistula should be ready for use. The physical findings suggest an outflow stenosis or other anatomical problem. The most appropriate next step is to obtain imaging, such as a duplex ultrasound or a fistulogram, to identify the underlying issue, which may be amenable to percutaneous intervention. Proceeding with cannulation is unsafe and likely to fail. Placing a catheter is premature before investigating the cause of fistula failure. Waiting longer is unlikely to result in maturation without intervention.

New-onset diabetes after transplantation (NODAT) is a common metabolic complication. The risk is significantly increased by certain immunosuppressive agents. Both glucocorticoids (prednisone) and calcineurin inhibitors (especially tacrolimus) are known to be diabetogenic. Prednisone induces insulin resistance, while tacrolimus is directly toxic to pancreatic beta cells. Mycophenolate mofetil is not significantly associated with the development of NODAT. Therefore, the combination of tacrolimus and prednisone is the most likely cause of this patient's hyperglycemia.

This patient has multiple contraindications to home-based dialysis modalities. His extensive abdominal surgical history makes peritoneal dialysis (both CAPD and APD) high-risk due to potential adhesions affecting catheter function and fluid distribution. His near-blindness and lack of a full-time caregiver make both home hemodialysis and peritoneal dialysis unsafe and impractical, as these require significant patient or caregiver ability for sterile technique and machine operation. Therefore, in-center hemodialysis, where treatment is administered by trained medical staff, is the safest and most appropriate option.

The timing of infection post-transplant is critical for diagnosis. The period from 1 to 12 months is the highest risk for opportunistic infections, particularly CMV. This patient's subacute presentation with pneumonitis (fever, cough, dyspnea) and diffuse interstitial infiltrates is classic for CMV infection. While PJP can present similarly, it is less likely given that the patient is compliant with prophylaxis. S. pneumoniae typically causes an acute, lobar pneumonia. BK virus primarily causes nephropathy, not pneumonitis.

Vancomycin is a large molecule that is significantly cleared by high-flux hemodialysis. Dosing must be adjusted for renal failure and the dialysis schedule. The standard approach is to give a loading dose, followed by smaller maintenance doses administered after each dialysis session to replace the drug that was removed. Dosing is then guided by pre-dialysis trough levels. Fixed daily or every-48-hour dosing is inappropriate as it does not account for clearance during dialysis and can lead to either toxic or sub-therapeutic levels. A maintenance dose of 500-750 mg post-dialysis is a common starting point.

Intradialytic hypotension is a common complication of hemodialysis, primarily caused by rapid fluid removal exceeding the plasma refilling rate. The immediate management involves two key steps: first, reducing or temporarily stopping ultrafiltration to halt further volume loss, and second, rapidly expanding the intravascular volume with an intravenous bolus of isotonic crystalloid (e.g., 100-250 mL of normal saline). Placing the patient in the Trendelenburg position is also helpful. Albumin is a second-line agent for refractory cases. Stopping the session is premature, and midodrine is an oral agent used for prevention, not acute treatment.

This question requires identifying a meal high in both potassium and phosphorus. French fries (from potatoes) are a major source of potassium. Cheese and processed meat (burger patty) are significant sources of phosphorus. The whole wheat bun also contains more phosphorus than a white bun. The other meal options are lower in both electrolytes: chicken and rice are acceptable protein and carb sources; shrimp salad is low in K and Phos; egg whites and white toast are also safe choices.