Thinking Outside the Box: Novel Kidney Protective Strategies in Kidney Transplantation
- PMID: 33757985
- PMCID: PMC8729499
- DOI: 10.2215/CJN.15070920
Thinking Outside the Box: Novel Kidney Protective Strategies in Kidney Transplantation
Abstract
Despite the reduction in the incidence of acute rejection, a major risk factor for graft loss, there has been only modest improvement in long-term graft survival. Most cases of kidney graft loss have an identifiable cause that is not idiopathic fibrosis/atrophy or calcineurin inhibitor nephrotoxicity. Distinct immunologic and nonimmunologic factors conspire to lead to a common pathway of allograft fibrosis. It remains plausible that mitigating nonimmunologic damage using strategies proven effective in native kidney disease may yield benefit in kidney transplantation. In this review, we will focus on nonimmunologic aspects of kidney transplant care that may prove to be valuable adjuncts to a well-managed immunosuppression regimen. Topics to be addressed include the roles of hypertension and agents used to treat it, lipid lowering, sodium and water intake, elevated uric acid, metabolic acidosis, and the use of sodium-glucose cotransporter 2 inhibitors on long-term kidney transplant health.
Keywords: hypertension; kidney transplantation; outcomes.
Copyright © 2021 by the American Society of Nephrology.
Comment on
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Managing Patients with Failing Kidney Allograft: Many Questions Remain.Clin J Am Soc Nephrol. 2022 Mar;17(3):444-451. doi: 10.2215/CJN.14620920. Epub 2021 Mar 10. Clin J Am Soc Nephrol. 2022. PMID: 33692118 Free PMC article. Review.
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Introduction to Kidney Transplantation: Long-Term Management Challenges.Clin J Am Soc Nephrol. 2021 Aug;16(8):1262-1263. doi: 10.2215/CJN.13440820. Epub 2021 Mar 10. Clin J Am Soc Nephrol. 2021. PMID: 33692119 Free PMC article. No abstract available.
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Post-Transplant Pregnancy and Contraception.Clin J Am Soc Nephrol. 2022 Jan;17(1):114-120. doi: 10.2215/CJN.14100820. Epub 2021 Mar 17. Clin J Am Soc Nephrol. 2022. PMID: 33731339 Free PMC article.
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