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Related Concept Videos

Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Kidney Transplant II: Surgical Procedure01:26

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
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Acute Kidney Injury III: Clinical Manifestations01:29

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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
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Late kidney dysfunction in a kidney transplant recipient.

Michelle A Josephson1

  • 1Section of Nephrology, University of Chicago Medicine, Chicago, Illinois.

Clinical Journal of the American Society of Nephrology : CJASN
|December 28, 2013
PubMed
Summary

Late kidney transplant dysfunction is increasingly linked to antibody-mediated rejection, not just calcineurin inhibitor toxicity. This shift impacts understanding of graft failure and treatment strategies for kidney transplant recipients.

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Area of Science:

  • Nephrology
  • Transplant Immunology
  • Immunopathology

Background:

  • Traditionally, calcineurin inhibitor toxicity was considered the primary cause of late kidney transplant dysfunction and graft failure.
  • Recent research challenges this long-held belief, prompting a re-evaluation of rejection mechanisms.

Observation:

  • Peritubular capillary C4d staining in kidney allografts is a key indicator of antibody-mediated injury.
  • Biopsy findings support the role of antibody-mediated rejection in late graft dysfunction.

Findings:

  • Antibody-mediated rejection is now recognized as a major contributor to late kidney allograft dysfunction and loss.
  • De novo donor-specific antibodies develop in 20-30% of kidney transplant patients post-transplant.

Implications:

  • The emergence of antibody-mediated rejection as a significant factor necessitates new diagnostic and therapeutic approaches.
  • Current treatment strategies are largely off-label, highlighting the need for FDA-approved therapies and rigorous clinical trials for antibody-mediated rejection.