Rejection of the kidney transplant
1. Use a systematic, algorithmic approach to AKI in the kidney transplant patient. Remember, not all AKI is rejection.
2. The possibility of inadequate immunosuppression should be considered whenever acute rejection is confirmed.
3. Acute AMR includes documentation of circulating DSA, C4d staining in the peritubular capillaries, and allograft pathology consistent with this diagnosis. However, C4d negative AMR is a recognized form of AMR.
4. Transplant glomerulopathy is a main cause of long-term graft loss. Proteinuria and serum creatinine may be stable and rise only after significant pathological damage has been done.
5. Multiple factors, both alloantigen-dependent and alloantigen-independent, appear to contribute to the pathogenesis of chronic graft dysfunction.