Challenges and considerations in diagnosing the kidney disease in deteriorating graft function.
Despite significant reductions in acute-rejection rates with the introduction of calcineurin inhibitor (CNI)-based immunosuppressive therapy, improvements in long-term graft survival in renal transplantation have been mixed. Improving long-term graft survival continues to present a major challenge in the management of kidney-transplant patients. CNIs are a key component of immunosuppressive therapy, and chronic CNI toxicity has been widely thought to be a major factor in late graft failure. However, recent studies examining the causes of late graft failure in detail have challenged this view, highlighting the importance of antibody-mediated rejection and other factors. In addition, the diagnosis of CNI nephrotoxicity represents a challenge to clinicians, with the potential for over-diagnosis and an inappropriate reduction in immunosuppressive therapy. When graft function is deteriorating, accurately determining the cause of the kidney disease is essential for effective long-term management of the patient. Diagnosis requires a thorough clinical investigation, and in the majority of cases a specific cause can be identified.
Department of Nephrology and Transplantation, Skåne University Hospital, Lund University, Malmö, Sweden. henrik.ekberg@med.lu.se
Henrik
H
Ekberg
Martin E
ME
Johansson
D065095:Calcineurin Inhibitors; D004791:Enzyme Inhibitors / Q000009:adverse effects; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects; D016030:Kidney Transplantation / Q000401:mortality; D051437:Renal Insufficiency / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D012307:Risk Factors
D065095:Calcineurin Inhibitors; D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents