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Chronic Allograft Nephropathy

Chronic Allograft Nephropathy basics

What is Chronic Allograft Nephropathy (CAN)?

Chronic Allograft Nephropathy (CAN) is the most prevalent cause of graft dysfunction and loss after renal transplantation. It is a histopathological diagnosis used to denote features of chronic interstitial fibrosis and tubular atrophy within the renal allograft.

The term Chronic Allograft Nephropathy was proposed in 1991, and it replaced the previously used term "chronic rejection", with aims of unifying chronic histological changes seen under light microscopy, such as interstitial fibrosis, tubular atrophy, transplant glomerulopathy and vasculopathy. The pathophysiology behind each of these features may nevertheless be different.

Pathogenesis of Chronic Allograft Nephropathy (CAN)

The pathogenesis of CAN has remained elusive. It is thought to initiate from a series of challenges to the allograft. Injury to the graft may begin even before the effect of the alloresponse: donor brain death, warm or cold ischemia, and ischemia/reperfusion injury all lead to increased immunogenicity in the graft, causing increased inflammatory alloresponse after the revascularization of the allograft.

During the first week after transplantation, the above series of injuries continues. Acute tubular necrosis, acute rejection episodes, and infections in the graft, etc contribute to the injury of the transplanted kidney. The renal injury may occur as a result of inflammatory response. Recipient lymphocytes and monocytes enter the graft and produce cytokines, which stimulate inflammatory and mesenchymal cells to make excess growth factors, leading to proliferation of myofibroblasts and smooth muscle cells in the vascular wall and increased collagen synthesis in fibroblasts. As a result of this process, scar forms, and histopathological changes in End Stage Renal Disease can be seen.

Risk factors of CAN include advanced donor age, delayed graft function, repeated acute rejection episodes, vascular rejection episodes, and rejections that occur late after transplantation.

If you have been diagnosed with Chronic Allograft Nephropathy, we're here to help. Call us: +86-311-86954186 OR Viber/Whatsapp: +86 13503211882 OR email us: kidneyabc@hotmail.com(Monday through Sunday) to make an appointment.

Chronic Allograft Nephropathy symptoms

Chronic Allograft Nephropathy (CAN) is characterized by a relatively slow but variable rate of decreased kidney function after the initial three post-transplant months, often combines with protein in the urine and hypertension. CAN and death with a functioning graft retain the leading causes of renal graft loss, together accounting for 3-5 percent of annual kidney graft loss, after the first year post-transplant.

There may be no clinical manifestations for some time despite of ongoing pathological process. Then, some moths or few years later after the transplant, there may be gradually increased serum creatinine levels, with the development of high blood pressure and low-grade urine protein, the three occurring simultaneously or in isolation.

Part reason of diagnostic delay is due to the recognized low accuracy of serum creatinine as a marker of graft function, as this lab value fails to show progressive loss of renal function in this and other settings.

If you have been diagnosed with Chronic Allograft Nephropathy, we're here to help. Call us: +86-311-86954186 OR Viber/Whatsapp: +86 13503211882 OR email us: kidneyabc@hotmail.com(Monday through Sunday) to make an appointment.

Chronic Allograft Nephropathy treatment

Management of Chronic Allograft Nephropathy (CAN) is now still limited to modifiable conditions, including immunosuppressive regimen; treatment of symptoms like proteinuria, hypertension, etc; management of complications.

1. Conventional Treatment

·Immunosuppressive regimen

Certain newer immunosuppressive drugs, especially those that also inhibit smooth muscle cell and myofibroblast proliferation, have been shown effective in animal models to prevent CAN. Unfortunately, there is not yet certification that these drugs can decrease the disease in humans.

·Symptomatic therapy

Hypertension. This condition affects about 80 percent of renal transplant recipients. Certain drugs have been used for good control of BP level.

Proteinuria. This symptom is highly prevalent after kidney transplant, occurring in up to 45 percent of the patients. Restriction of dietary protein and the use of ACE inhibitors or ARB can reduce proteinuria.

Dyslipidemias. This condition occurs in around 60 percent of the patients within the first year post-transplantation, with suggestion that they may develop Chronic Renal Allograft Dysfunction. Initial treatment involves lifestyle changes including diet, weight reduction, and physical exercises. Sometimes, modification of the immunosuppressants application may be necessary for control of the symptom.

·Management of complications.

Anemia is a common complication that affect about 20~40 percent of post-transplanted patients due to multi-factors such as graft function (and associated EPO production), iron deficiency, blood loss, infections and commonly used drugs (some immunosuppressants, ACE inhibitors, and ARB). Treatment must target the cause.

2. Novel treatment for Chronic Allograft Nephropathy - Immunotherapy

Chronic Allograft Nephropathy is the major causes of long-term kidney allograft failure. With a failed transplant for the first time, patient often have to restart kidney dialysis or receive a kidney transplant once again. However, the difficulty of multi-transplantation is high, many patients experience mental disorders in varied degrees.

The good news is that a new promising approach for improving the kidney function and avoiding re-transplant has been developed in China. It is known as Immunotherapy.

The concept of Immunotherapy against kidney disease is based on regulation of the body's overall immune system. This therapy has proven to be one of the most effective treatment strategies for transplanted kidney failure. Under the holistic treatment, many people with failed transplantation have successfully avoided a new transplant and regained a normal life.

If you have been diagnosed with Chronic Allograft Nephropathy, we're here to help. Call us: +86-311-86954186 OR Viber/Whatsapp: +86 13503211882 OR email us: kidneyabc@hotmail.com(Monday through Sunday) to make an appointment.

Chronic Allograft Nephropathy diagnosis

Long term survival of kidney transplants is hampered by Chronic Allograft Nephropathy (CAN), which causes graft failure and eventually leads to graft loss of re-transplantation.

Diagnosis of Chronic Allograft Nephropathy

Clinically, the disease is characterized by a slow but variable loss of function, starting 3 months after implantation, often combined with proteinuria generally in the non-nephritic range and high blood pressure.

Often, the first indication of the condition is increasing serum creatinine or the development of overt proteinuria. In these cases, patients experience progressive decline of kidney function.

It should be noticed that a single reference range for serum creatinine can be misleading and often underestimates the deterioration of kidney function, especially at GFR between 30~70mL/min. Patient may have suffer from a considerable amount of damage when the creatinine level begin to rise.

Besides, other scoring methods include chronic allograft damage index, etc. These indexes as well as some selected histopathological findings (e.g. interstitial fibrosis) have been used as predictive markers of CAN. Histological alterations are, however, the late stage of cascade of events leading to CAN.

If you have been diagnosed with Chronic Allograft Nephropathy, we're here to help. Call us: +86-311-86954186 OR Viber/Whatsapp: +86 13503211882 OR email us: kidneyabc@hotmail.com(Monday through Sunday) to make an appointment.

Chronic Allograft Nephropathy knowledge

Most late renal allograft loss, other than that associated with the death of the patient, has been attributed to progressive renal dysfunction, called "Chronic Allograft Nephropathy". It represents an incremental damage to the nephrons (functional units of the kidneys) from time-dependent immunologic and non-immunologic causes.

Several years after the transplantation, the functioning new kidney may deteriorate gradually. However, the biopsy of the transplanted kidney may not show that immunocytes are attacking the kidney. In this condition, the functions of the transplanted kidney progress of arterial sclerosis or toxicity of the immunosuppressants occur in the kidney and lead to decline of renal functions. People with recurring Nephritis or Diabetes may have nephropathy resulting from Diabetes. So the reduced functions of the transplanted kidney are not attributable to a single cause.

Chronic Allograft Nephropathy

What it's not

Rejection

What it is

·Variable loss in kidney function

·Decrease in GFR

·Non-specific pathology

·Proteinuria

·Hypertension (high blood pressure)

How to improve care for CAN patients?

·Early identification

·Education

·Manage co-morbidity well

·Modify dietary arrangement

·Mental Health

·Exercise/weight control

If you have been diagnosed with Chronic Allograft Nephropathy, we're here to help. Call us: +86-311-86954186 OR Viber/Whatsapp: +86 13503211882 OR email us: kidneyabc@hotmail.com(Monday through Sunday) to make an appointment.

Chronic Allograft Nephropathy health care

Patients who have receive a kidney transplant need to pay attention to many aspects of daily life. Here are some useful suggestions.

·Quit smoking and don't drink alcohol. Tobacco products and alcohol have certain stimulative effects to human body, which may increase the kidneys' workload. This is not good for patient's recovery.

·Pay attention to daily diet.

1. Ensure the dietetic hygiene. After the transplantation, patient need to take large amount of immunosuppressive drugs, which may decrease his resistance against outer pathogenic bacteria. Avoid eating dirty foods that may bring unknown germs into the body.

2. Eat meals regularly on time. This is a good living habit which is beneficial for transplanted patient's health.

3. Refer to digestible foods that contain high-quality protein, low-fat, low-sugar and rich in vitamins.

·Do regular check-ups of the weight, body temperature, blood pressure, etc and make detailed records. Besides, avoid catching a cold or flu. Pay attention to personal hygiene.

·Take medicines strictly according to the doctor's advice. Do not stop medicines on one's own or increase the dose so as to avoid rejection or poison.

·Keep a stable, optimistic, and positive attitude. Balance work and rest. Have a correct knowledge of the kidney disease.

·Undertake work within one's capability six months or one year later if the disease have been well controlled.

·Sex and pregnancy. After transplant, most patients can get married and give birth to a child. They are often suggested to start sexual life six months later. Never being indulgent and avoid harming the transplanted kidney. Women with transplanted kidney can consider to get pregnant two years' later of the surgery. Ask the doctor about more details.

If you have been diagnosed with Chronic Allograft Nephropathy, we're here to help. Call us: +86-311-86954186 OR Viber/Whatsapp: +86 13503211882 OR email us: kidneyabc@hotmail.com(Monday through Sunday) to make an appointment.

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