For a transplant patient exhibiting worsening renal function and proteinuria, what treatment adjustment is typically recommended?

In transplant patients experiencing worsening renal function and proteinuria, the approach often involves managing immunosuppression to reduce nephrotoxic effects. Weaning steroids can be a strategic decision as it may help improve renal outcomes. Corticosteroids are known to have various side effects, including the potential to worsen renal function indirectly through diabetes worsening and promoting nephrotoxicity.

In the context of managing transplant patients, decreasing steroid doses can also help mitigate proteinuria. By tapering steroids, clinicians may see an improvement in overall renal function and possibly a reduction in proteinuria, as steroids can exacerbate renal damage over time due to their effects on metabolic pathways and inflammation.

Other management options, such as switching to everolimus or adjusting existing immunosuppressants, also aim to reduce the burden on renal function but would require careful consideration of overall immunosuppression and rejection risk for the individual patient. Adjusting the tacrolimus dose or switching immunosuppressants may not be the immediate approach in the setting presented, given these medications' complexities and the need for maintaining sufficient immunosuppression while also considering renal health.