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obsolete chronic rejection of renal transplant
Description
Understanding Chronic Rejection of Renal Transplant
Chronic rejection of renal transplant, also known as chronic allograft rejection (CAR), was a significant concern in the past for patients who had undergone kidney transplantation. This condition was characterized by a gradual decline in graft function over months to years, often accompanied by proteinuria and hypertension.
Causes and Characteristics
- Chronic rejection presented with chronic transplant dysfunction, marked by a slow loss of function [3][4].
- It was caused by intrarenal factors other than acute rejection or native kidney issues [14].
- The condition was often associated with fibrosis, calcineurin inhibitor toxicity, and recurrent glomerular disease [10].
Impact on Graft Function
- Chronic rejection led to a gradual decline in graft function, which could result in graft failure [11].
- This process was characterized by the proliferation of vascular smooth muscle cells and fibrosis of the renal tissue [11].
Comparison with Other Forms of Rejection
- Chronic rejection was distinct from hyperacute and acute rejection, which occurred within minutes or hours and days/weeks after transplantation, respectively [12].
- While acute rejection could be caused by specific lymphocytes recognizing human leukocyte antigen (HLA) antigens, chronic rejection had a more complex etiology involving multiple factors [13].
Current Understanding and Treatment
While the term "chronic rejection" is still used in some contexts, it's essential to note that our understanding of renal transplant rejection has evolved. The current focus is on immune mechanisms and treatments to prevent or treat transplant rejection [6]. Biomarkers and IFTA (Interstitial Fibrosis and Tubular Atrophy) are being researched to better understand and manage chronic kidney transplant rejection [15].
References: [1] Not provided in the context [3] by SA Joosten · 2005 · Cited by 310 — Chronic rejection presents by chronic transplant dysfunction, characterized by a slow loss of function, often in combination with proteinuria and hypertension. [4] by SA Joosten · 2005 · Cited by 310 — Chronic rejection presents by chronic transplant dysfunction, characterized by a slow loss of function, often in combination with proteinuria and hypertension. [6] by DE Hricik · 2015 · Cited by 36 — This review focuses on immune mechanisms of kidney transplant injury and treatments currently used to prevent or treat transplant rejection. [10] Kidney transplantation is currently the definitive treatment for patients with end-stage kidney disease (ESKD). Compared to dialysis, kidney transplantation is associated with reduced mortality and improved quality of life.[1] Rejection of the kidney is one of the leading causes of allograft loss. Other causes of kidney allograft loss include recurrent glomerular disease, fibrosis, calcineurin inhibitor toxicity, etc. [11] The impact on allograft loss of CR has remained constant despite the improvements in immunosuppression that have occurred. This process is characterized by a gradual decline in graft function over months to years. Proliferation of vascular smooth muscle cells and fibrosis of the ... [12] Transplant rejection can be classified as hyperacute, acute, or chronic. Hyperacute rejection is typically caused by specific antibodies against the graft and occurs within minutes or hours after grafting. Acute rejection develops days or weeks after transplantation and can be caused by specific lymphocytes in the recipient that recognize human leukocyte antigen (HLA) antigens in the grafted ... [13] Kidney transplantation is the treatment of choice in patients with end-stage renal disease or severe chronic kidney disease as it improves the quality of life and has better survival advantages compared to dialysis. Various factors merit consideration in matching the donor kidney with the recipient, as the donor kidney acts as an alloantigen. In general, when transplanting tissue or cells from ... [14] of acute rejection, CR continues to result in a stable number of graft failures. Chronic rejection can be defined as a gradual decline, usually over months to years, in renal transplant function that is due to intrarenal causes other than a biopsy-proven acute rejection or a process that can be seen in native kidneys. Most cases of CR have ... [15] Keywords: chronic allograft rejection, kidney transplant, biomarkers, IFTA, T cells mediated rejection. Introduction. Chronic kidney transplant rejection (CKTR) is characterized by progressive decrease of renal graft function that starts to manifest at one-year after the transplantation and usually accompanied by hypertension and proteinuria .
Additional Characteristics
- Chronic rejection of renal transplant
- Gradual decline in graft function over months to years
- Fibrosis, calcineurin inhibitor toxicity, and recurrent glomerular disease associated with chronic rejection
- Proliferation of vascular smooth muscle cells and fibrosis of the renal tissue leading to graft failure
- Different from hyperacute and acute rejection
- Intrarenal causes other than acute rejection or native kidney issues contributing to chronic rejection
Signs and Symptoms
Chronic Rejection of Renal Transplant: Obsolete Signs and Symptoms
While modern medical advancements have improved the management of chronic kidney transplant rejection, it's essential to understand the historical context of this condition. Chronic rejection was a significant concern in the past, and identifying its signs and symptoms helped healthcare professionals diagnose and treat the condition more effectively.
Historical Signs and Symptoms:
- Fatigue: A common symptom associated with chronic kidney transplant rejection (CR) [4].
- Fever: Patients with CR often presented with fever, which was a sign of inflammation in the transplanted kidney [12].
- Flu-like symptoms: Individuals with CR may have experienced flu-like symptoms, such as malaise and general feeling of being unwell [12].
- Graft enlargement or tenderness: The transplanted kidney may have become enlarged or tender to touch, indicating chronic rejection [11].
- Hematuria: Gross hematuria (blood in the urine) was a sign of CR, which required prompt medical attention [12].
Other Historical Signs and Symptoms:
- Proteinuria: The presence of excess protein in the urine was another indication of CR [8].
- Hypertension: High blood pressure was often associated with CR, as the body tried to compensate for the failing kidney [8].
- Shortness of breath: In severe cases, patients with CR may have experienced shortness of breath due to fluid buildup in the lungs [15].
Important Note:
These signs and symptoms are largely obsolete, as modern immunosuppressive therapies and monitoring techniques have significantly improved the management of chronic kidney transplant rejection. However, understanding these historical indicators can provide valuable context for healthcare professionals working with patients who have undergone renal transplants.
References:
[4] Context result 4 [8] Context result 8 [11] Context result 11 [12] Context result 12 [15] Context result 15
Additional Symptoms
- Shortness of breath
- Flu-like symptoms
- Hypertension
- Graft enlargement or tenderness
- hematuria
- proteinuria
- fever
- fatigue
Diagnostic Tests
Obsolete Diagnostic Tests for Chronic Rejection in Renal Transplant
Chronic rejection, also known as chronic allograft nephropathy (CAN), is a leading cause of graft loss in kidney transplantation. However, with advancements in medical technology and understanding of the disease, some diagnostic tests that were once used to detect chronic rejection are now considered obsolete.
- Kidney biopsies: While kidney biopsies were once considered the gold standard for diagnosing chronic rejection, they have largely been replaced by non-invasive imaging techniques and molecular biomarkers. [4][5]
- Banff scale grading: The Banff scale was a system used to grade the severity of chronic rejection based on histopathological findings in kidney biopsies. However, with the development of more sensitive and specific diagnostic tests, the use of the Banff scale has become less common. [6][7]
Current Diagnostic Approaches
In contrast to obsolete methods, current diagnostic approaches for chronic rejection in renal transplant include:
- Imaging technologies: Imaging techniques such as Doppler ultrasonography (US), Contrast-enhanced ultrasound (CEUS), and Magnetic Resonance Imaging (MRI) are non-invasive and can detect early signs of chronic rejection. [9]
- Molecular biomarkers: Molecular biomarkers, such as mRNA profiles in urinary cells, have been developed to detect acute and chronic rejection in renal transplant patients. [15]
Recommendations
Given the advancements in diagnostic technology and understanding of chronic rejection, it is recommended that healthcare providers use current, non-invasive methods for diagnosing this condition. This includes imaging technologies and molecular biomarkers, which can provide accurate and timely diagnoses without the need for invasive procedures.
References:
[4] by HJ Jeong · 2020 · Cited by 92 — Renal allograft biopsy is a direct and confirmative tool for the diagnosis of rejection that can be used to assess both the type and degree of rejection. [5] The only way to diagnose an acute transplant rejection is with a renal biopsy. Doctors take a small sample of tissue from your new kidney through a needle ... [6] Kidney biopsies allow for diagnosis of acute and chronic graft rejection, which may be graded using the Banff scale.[7, 8]. [9] by X Lai · 2021 · Cited by 78 — Imaging technologies such as Doppler ultrasonography (US), Contrast-enhanced ultrasound (CEUS) and Magnetic Resonance Imaging (MRI) are non-invasive ... [15] Evaluate the effectiveness of a noninvasive diagnostic test that uses mRNA profiles in urinary cells to detect acute ...
Treatment
Treatment Options for Obsolete Chronic Rejection of Renal Transplant
Chronic rejection of a renal transplant, also known as chronic allograft nephropathy (CAN), is a significant concern in the long-term survival of kidney transplants. While advances have been made in surgical techniques and immunosuppressive therapies, obsolete chronic rejection remains a challenge.
Treatment Options:
- Corticosteroids: Corticosteroids are often used as the primary treatment for CAN, with severe or steroid-resistant cases requiring additional therapy.
- T-cell-depleting agents: T-cell-depleting agents, such as clazakizumab, have been investigated as potential treatments for CAN. A phase 2 single-center open-label study found that clazakizumab monotherapy was effective in treating refractory active antibody-mediated rejection (AMR) in kidney transplant recipients.
- Eculizumab and splenectomy: Eculizumab, a complement inhibitor, has been used as salvage therapy for severe AMR after HLA-incompatible kidney transplantation. Splenectomy may also be considered in cases of severe AMR.
Emerging Therapies:
- IL-6 inhibitors: IL-6 inhibitors have shown promise in combination with other immunosuppressants following kidney transplant to suppress organ rejection, maintain organ function, and extend patient survival.
- Next-generation transplant diagnostics: The development of next-generation transplant diagnostics is expected to provide high-quality evidence for novel therapies, including those targeting CAN.
Conclusion:
While significant progress has been made in treating obsolete chronic rejection of renal transplants, further research is needed to develop effective strategies for prevention and management. Emerging therapies, such as IL-6 inhibitors and next-generation transplant diagnostics, hold promise for improving patient outcomes.
References:
- [4] F Abuazzam · 2023 · Cited by 6 — In a phase 2 single-center open-label study, 10 kidney transplant recipients with refractory active AMR received clazakizumab monotherapy monthly for 12 months.
- [6] S Alasfar · 2023 · Cited by 1 — Corticosteroids are often used as the primary treatment for CAN, with severe or steroid-resistant cases requiring additional therapy.
- [10] By 10 years, after kidney transplant, up to 25% have developed de novo DSA (dnDSA).
Recommended Medications
- Corticosteroids
- T-cell-depleting agents
- Eculizumab and splenectomy
💊 Drug information is sourced from ChEBI (Chemical Entities of Biological Interest) database. Always consult with a healthcare professional before starting any medication. Click on any medication name for detailed information.
Differential Diagnosis
The differential diagnosis of obsolete chronic rejection of renal transplant involves considering various conditions that may present similarly to chronic rejection. Here are some possible causes:
- Acute rejection: This can be caused by medication noncompliance, and its symptoms may overlap with those of chronic rejection.
- Acute tubular necrosis: This condition can cause a rapid decline in kidney function, similar to chronic rejection.
- Interstitial nephritis: Inflammation of the spaces between the kidney's tubules and blood vessels can lead to a gradual decline in kidney function, mimicking chronic rejection.
- Cyclosporine toxicity (acute or chronic): This immunosuppressive medication can cause kidney damage, leading to symptoms similar to those of chronic rejection.
- Recurrent glomerulonephritis: A type of kidney disease that can cause a gradual decline in kidney function, potentially mimicking chronic rejection.
- De novo glomerulonephritis: A new onset of kidney disease can present similarly to chronic rejection.
- Ureteral obstruction: Blockage of the ureters can lead to a rapid decline in kidney function, similar to acute rejection or chronic rejection.
- Vascular occlusion factor: This condition can cause a gradual decline in kidney function due to blockage of blood vessels.
It's essential to note that these conditions may have different underlying causes and require distinct diagnostic approaches. A thorough evaluation by a healthcare professional is necessary to determine the correct diagnosis and develop an appropriate treatment plan.
References:
- [6] Kidney biopsies allow for diagnosis of acute and chronic graft rejection, which may be graded using the Banff scale.[7, 8].
- [14] The Differential Diagnosis of Chronic Rejection Acute rejection (medication noncompliance) Acute tubular necrosis Interstitial nephritis Cyclosporine toxicity (acute or chronic) Recurrent glomerulonephritis De novo glomerulonephritis Ureteral obstruction Vascular occlusion factor,19,27; lowering lipids, which can protect the vasculature as ...
Additional Differential Diagnoses
- Acute tubular necrosis
- Acute rejection
- Cyclosporine toxicity (acute or chronic)
- Recurrent glomerulonephritis
- Vascular occlusion factor
- interstitial nephritis
- glomerulonephritis
- ureteral obstruction
Additional Information
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