[Post-transplant nephropathy and arterial hypertension]

Area of Science:

• Nephrology
• Immunology
• Cardiology

Context:

• Kidney transplantation outcomes have improved with new immunosuppressive drugs.
• Late graft loss remains a significant challenge, occurring in about 5% of renal transplants annually.
• Both immunological and non-immunological factors contribute to chronic post-transplant nephropathy.

Purpose:

• To review the non-immunological factors, particularly hypertension, contributing to late kidney transplant loss.
• To highlight the multifaceted role of hypertension in chronic allograft nephropathy.
• To discuss management strategies for post-transplant hypertension and its impact on graft survival.

Summary:

• Hypertension, hyperlipidemia, proteinuria, and immunosuppressive drug toxicity are key non-immunological factors in chronic post-transplant nephropathy.
• Hypertension can be a cause or consequence of graft failure, exacerbated by factors like hypercholesterolemia and immunosuppressants (corticosteroids, cyclosporine A).
• Management involves controlling arterial pressure below 140/90 mmHg, reducing protein and salt intake, and utilizing pharmacological treatments like ACE inhibitors, ARBs, and calcium channel blockers.

Impact:

• Effective management of hypertension is vital for improving long-term kidney transplant survival.
• Understanding and addressing non-immunological factors can reduce the rate of late graft loss.
• Pharmacological interventions can mitigate hypertension-related complications and protect renal grafts.