Renal Graft Rejection

After effective functioning for several years transplanted kidney suddenly ceases to function resulting chronic rejection.

Signs & Symptoms of Chronic Renal Graft Rejection

The signs and symptoms of chronic rejection include the following:

  • Hardening of renal vessels (nephrosclerosis)
  • Hardening proliferating up to Vascular intima (innermost layer) of renal vessels
  • Marked decrease in lumen of the vessel

Results of Renal Graft Rejection

The symptoms often lead to following severe complications:

  • Renal ischemia
  • Hypertension
  • Tubular atrophy
  • Interstitial fibrosis
  • Nephrogenic systemic fibrosis (NSF)
  • Glomerular atrophy
  • Eventual renal failure

Causes for Renal Graft Rejection

The following factors usually contribute to renal graft rejection:

  • HLA incompatibility
  • Age
  • Number of nephrons
  • Ischemic history of a donor kidney

The causes of renal graft vary with the time (usually classified as immediate, early, and late period) after transplantation. Depending on the time, different causes such as prerenal, post renal and intrinsic causes of failure are generally proposed.

Serum creatinine level:

During initial stages when renal function is sound increase in serum creatinine level is the most sensitive and reliable indicator of possible graft rejection


useful in ascertaining changes in the renal vasculature

Radioactive iodohippurate:

sodium renograms of the transplanted kidney helpful in evaluating the renal blood flow, even in the absence of urinary flow.

Renal biopsy:

Calcineurin inhibitors (cyclosporine or tacrolimus) may cause slow deterioration in renal function that is very similar to graft rejection. Renal biopsy is the only method recommend to diagnose this.

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