Minimizing the risk of chronic allograft nephropathy.
Chronic allograft nephropathy, now defined as interstital fibrosis and tubular atrophy not otherwise specified, is a near universal finding in transplant kidney biopsies by the end of the first decade posttransplantation. After excluding death with functioning graft, caused by cardiovascular disease or malignancy, chronic allograft nephropathy is the leading cause of graft failure. Original assumptions were that this was not a modifiable process but inexorable, likely due to past kidney injuries. However, newer understandings suggest that acute or subacute processes are involved, and with proper diagnosis, appropriate interventions can be instituted. Our method involved a review of the primary and secondary prevention trials in calcineurin inhibitor withdrawal. Some of the more important causes of progressive graft deterioration include subclinical cellular or humoral rejection, and chronic calcineurin inhibitor toxicity. Early graft biopsy, assessment of histology, and changes in immunosuppression may be some of the most important measures available to protect graft function. The avoidance of clinical inertia in pursuing subtle changes in graft function is critical. Modification in maintenance immunosuppression may benefit many patients with early evidence of graft deterioration.
Weir
Matthew R
MR
Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD 21202, USA. mweir@medicine.umaryland.edu
Wali
Ravinder K
RK
D003404:Creatinine / Q000097:blood; D005919:Glomerular Filtration Rate / Q000502:physiology; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology* / Q000502:physiology; D018579:Patient Selection; D011183:Postoperative Complications / Q000517:prevention & control*; D011322:Primary Prevention; D012008:Recurrence; D040242:Risk Reduction Behavior; D055502:Secondary Prevention; D014019:Tissue Donors / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000473:pathology*; D017211:Treatment Failure
D003404:Creatinine