Clinical manifestations and diagnosis of acute renal allograft rejection
- W James Chon, MD, FACP, FASN, FAST
W James Chon, MD, FACP, FASN, FAST
- Associate Professor
- University of Missouri-Kansas City (UMKC) School of Medicine
- Medical Director, Renal Transplant Program
- St. Luke's Health System
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
Acute renal allograft rejection is a major cause of allograft dysfunction. Some kidneys do not regain function even with maximal antirejection therapy. (See "Acute renal allograft rejection: Treatment".)
Even among patients who recover, acute rejection episodes can have a negative impact on long-term graft survival. Acute rejection is a major predictor of interstitial fibrosis/tubular atrophy (IF/TA), formerly called chronic allograft nephropathy, which is responsible for most death-censored graft loss after the first year posttransplant. (See "Chronic renal allograft nephropathy", section on 'Importance of acute rejection'.)
There has been a dramatic reduction in the incidence of acute rejection due to the introduction of potent immunosuppressive drugs in the past three decades. However, optimizing immunosuppression to both prevent allograft rejection and minimize drug toxicity, infection, and malignancy remains challenging.
A discussion of the clinical manifestations and diagnosis of acute renal allograft rejection is presented in this topic review. The treatment of acute rejection is presented separately. (See "Acute renal allograft rejection: Treatment".)
Acute renal allograft rejection is defined as an acute deterioration in allograft function associated with specific pathologic changes in the graft. There are two principal histologic forms of acute rejection:
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- EPIDEMIOLOGY AND OUTCOMES
- Acute rejection
- Subclinical rejection
- CLINICAL FEATURES
- Clinical manifestations
- Laboratory manifestations
- Radiographic manifestations
- MONITORING FOR ACUTE REJECTION
- Laboratory monitoring
- Protocol (surveillance) biopsies
- Selection of patients for biopsy
- Histopathologic diagnosis
- DIFFERENTIAL DIAGNOSIS
- Clinical symptoms
- Elevated serum creatinine
- Histologic findings
- SUMMARY AND RECOMMENDATIONS