Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2009 Aug;24(8):1465-71.
doi: 10.1007/s00467-008-0869-z. Epub 2008 Jun 27.

Chronic allograft nephropathy

Jeffery T Fletcher  1 , Brian J Nankivell, Stephen I Alexander
Affiliations
Review

Chronic allograft nephropathy

Jeffery T Fletcher et al. Pediatr Nephrol. 2009 Aug.

Abstract

Chronic allograft nephropathy (CAN) is the leading cause of renal allograft loss in paediatric renal transplant recipients. CAN is the result of immunological and nonimmunological injury, including acute rejection episodes, hypoperfusion, ischaemia reperfusion, calcineurin toxicity, infection and recurrent disease. The development of CAN is often insidious and may be preceded by subclinical rejection in a well-functioning allograft. Classification of CAN is histological using the Banff classification of renal allograft pathology with classic findings of interstitial fibrosis, tubular atrophy, glomerulosclerosis, fibrointimal hyperplasia and arteriolar hyalinosis. Although improvement in immunosuppression has led to greater 1-year graft survival rates, chronic graft loss remains relatively unchanged and opportunistic infectious complications remain a problem. Protocol biopsy monitoring is not current practice in paediatric transplantation for CAN monitoring but may have a place if new treatment options become available. Newer immunosuppression regimens, closer monitoring of the renal allograft and management of subclinical rejection may lead to reduced immune injury leading to CAN in the paediatric population but must be weighed against the risk of increased immunosuppression and calcineurin inhibitor nephrotoxicity.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Schematic illustration of biopsy of a renal allograft showing histopathological features characteristic of chronic allograft nephropathy (CAN). Italics indicate potential precipitating factors for CAN associated with the areas they specifically target. Reprinted with permission from [51]
Fig. 2
Fig. 2
a Renal allograft biopsy (silver staining) showing features of transplant glomerulopathy with evidence of “double contours” in capillary loops, mesangial proliferation and matrix expansion and basement membrane thickening. b Renal allograft biopsy from a child with chronic allograft nephropathy (CAN) showing C4d deposition (in brown) in peritubular capillaries consistent with humoral-mediated rejection
See this image and copyright information in PMC

References

    1. Racusen LC, Solez K, Colvin RB, Bonsib SM, Castro MC, Cavallo T, Croker BP, Demetris AJ, Drachenberg CB, Fogo AB, Furness P, Gaber LW, Gibson IW, Glotz D, Goldberg JC, Grande J, Halloran PF, Hansen HE, Hartley B, Hayry PJ, Hill CM, Hoffman EO, Hunsicker LG, Lindblad AS, Yamaguchi Y. The Banff 97 working classification of renal allograft pathology. Kidney Int. 1999;55:713–723. - PubMed
    1. Isoniemi H, Taskinen E, Hayry P. Histological chronic allograft damage index accurately predicts chronic renal allograft rejection. Transplantation. 1994;58:1195–1198. - PubMed
    1. Solez K, Axelsen RA, Benediktsson H, Burdick JF, Cohen AH, Colvin RB, Croker BP, Droz D, Dunnill MS, Halloran PF. International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int. 1993;44:411–422. - PubMed
    1. Fuecht H, Felber E, Gokel MJ, Hillerbrand G, Nattermann U, Brockmeyer C, Held E, Riethmuller G, Land W, Albert E. Vascular deposition of complement-split products in kidney allografts with cell-mediated rejection. Clin Exp Immunol. 1991;86:464–470. - PMC - PubMed
    1. Nickeleitt V, Zeiler M, Gudat F, Thiel G, Mihatsch MJ. Detection of the complement degradation product C4d in renal allografts: Diagnostic and therapeutic implications. J Am Soc Nephrol. 2002;13:242–251. - PubMed