الفهرس 
End stage kidney disease and kidney transplantation.Only 14 pages are availabe for public view
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Abstract
Kidney disease is defined as end-stage when a patient’s glomerular filtration rate has fallen to <15 ml/min/1.73 m2 and renal transplantation has become the treatment of choice for most patients with end-stage renal disease (ESRD).But the immune response to the transplanted kidney leads to graft rejection and this is the major complication of transplantation . The central issue in organ transplantation remains suppression of allograft rejection. Thus, development of immunosuppressive drugs is the key to successful allograft function. Immunosuppressive agents are used for induction (intense immunosuppression in the initial days after transplantation), maintenance, and reversal of established rejection. The primary interest in developing new immunosuppressants no longer involves simply improving short-term results, but also improving the safety profile, , preserving kidney function and improving cardiovascular and metabolic profiles. Advances in immunosuppressive strategies over the past decades have led to significant improvements in the field of renal transplantation. Cyclosporine revolutionized transplant practice by lowering acute rejection rates and improving short-term graft survival in the 1980s. Post transplant outcomes improved further with tacrolimus and mycophenolic acid in the 1990s. Additionally, the use of induction immunosuppressive agents has lowered early acute rejection rates. Despite these advances, clear evidence for a beneficial effect on long-term graft survival is lacking as chronic allograft nephropathy continues to threaten the renal allograft. With newer immunosuppressive regimens, immunologic causes of early graft failure have become rare. However, late graft loss has remained virtually unchanged over the last few decades, because of the persistence of chronic allograft injury. The use of newer immunosuppressive agents such as belatacept , voclosporine and prolonged release tacrolimus are evolving strategies that aspire to minimize lifelong exposure to calcineurin inhibitors and corticosteroids and improves long term out comes as, lowering nephrotoxicity, and improving cardiovascular and metabolic profiles…. Furthermore, the tolerability and adverse effects of immunosuppressants are just as important as their efficacy, above all when taking into account that kidney transplant recipients are growing older, with associated cardiovascular comorbidities.