الفهرس 
Chronic KidneyAllograft LossOnly 14 pages are availabe for public view
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Abstract
In some patient with kidney allograft loss, the graft could be salvageable with immunosuppressive therapy or other medical cares and surgeon can postpone and even revoke graft nephrectomy for the decline of morbidity and mortality. In other patients if graft asymptomatic and graft biopsy was shown necrosis, we can leave the graft in situ for use of its advantages.
Progressive allograft dysfunction is detected by serial monitoring of serum creatinine concentrations and investigated by assessment of therapeutic drug concentrations, urinalysis, imaging, and a timely diagnostic biopsy. A careful collaborative diagnosis of the underlying cause should consider acute or chronic rejection (including antibody-mediated rejection), nonimmune factors such as pre-existing donor quality or early ischemia-reperfusion injury, recurrent glomerular disease, allograft BK viral infection, and calcineurin inhibitor nephrotoxicity. Treatment should be targeted towards the dominant pathophysiological diagnosis, include strengthening of immunosuppression for chronic rejection, or calcineurin inhibitor minimization, substitution, or elimination for nephrotoxicity.
Chronic renal allograft disease(CRAD) is now the main cause of graft loss. Immunologic and non-immunologic factors contribute to its development and lead to fibrosis, whose etiology is not always clear. Renal biopsy is essential for the detection of modifiable factors which may lead to adjustments to the immunosuppressive therapy. As it is recommended for CRD patients not on dialysis, adequate management of the conditions related to CRD progression may be useful to prolong patient survival and delay the progression of graft loss. However, there are no robust data, at present, to support these recommendations for the population of renal transplant recipients. Greater knowledge of the pathogenesis of the different causes of CRAD and of the fibrogenesis.