[Diagnosis and follow-up of chronic kidney graft dysfunction: from DFG to new biomarkers]

Chronic allograft dysfunction is an alteration of the renal graft's structure that causes renal function to deteriorate. It can be diagnosed histologically by the presence of interstitial fibrosis lesions and tubular atrophy beginning 3 months after transplantation. The predictive value of these lesions on graft loss is limited however. Kidney function is evaluated by measuring the glomerular filtration rate using reference methods such as urinary clearance of inulin. However, estimation of the glomerular filtration rate from plasma creatinine using the Cockroft or MDRD formulas is not a reliable marker of renal function loss in the transplantation patient; nor is it a good predictive marker of graft loss. To overcome the diagnostic and prognostic shortcomings of these traditional markers in transplantation patients, new biomarkers have been developed. Yet the advantages of these biomarkers in predicting the evolving complications of chronic allograft dysfunction as well as graft loss on the individual level now require validation.