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CLINICAL MANIFESTATIONS AND DIAGNOSIS OF ACUTE RENAL ALLOGRAFT REJECTION

One of the most common causes of allograft dysfunction is a rejected kidney graft, despite It’s became less prevalent

CLINICAL MANIFESTATIONS AND DIAGNOSIS OF ACUTE RENAL ALLOGRAFT REJECTION

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One of the most common causes of allograft dysfunction is a rejected kidney graft, despite It’s became less prevalent since the admission of more robust immunosuppressive strategies, especially the calcineurin inhibitors (CNI). Certain rejected grafts, however, cannot resume its function again despite the administration of maximum antirejection agents. The recurrence of acute rejection attacks may negatively affect the long-term allograft outcome. The two major types of acute rejection episodes are the cellular type and antibody mediated one.
Another subclinical form can be present if there’re histologic criteria in allograft biopsy with no associated allograft dysfunction.

Acute episodes of rejection can be observed through the first 6 months post-transplant. Rejection episode after 6 months, is primarily related to patient’s non-compliance or due to rapid   immunosuppressives reduction/withdrawal. Historically, the classic clinical manifestations may include pyrexia, malaise, oliguria (low urine output), locally tender/painful allograft, allograft swelling and hypertension (HT), however, with the advent of the new immunosuppressive protocols, this presentation is not common and many kidney transplant recipients (KTRs) mostly present only with a rise in serum creatinine levels (SCR) that suggest the possibility of a rejection episode.