[Prevention of chronic allograft nephropathy]. / Prevenzione della nefropatia cronica del rene trapiantato.

Chronic allograft nephropathy, characterized by interstitial fibrosis and tubular atrophy, is one of the main causes of allograft failure in the long term. It may be induced by several factors, immunogical or not in nature, which nephrologists must recognize in order to establish the appropriate treatment strategy and prevent progressive loss of graft function. Extensive use of graft biopsy, whether carried out by protocol or suggested by the clinical setting, is recommended for an accurate diagnosis of renal lesions and prompt identification of calcineurin inhibitor-induced toxicity or signs of immunological activity (i.e., subclinical rejection or chronic antibody-mediated rejection) requiring changes of immunosuppressive strategy.

[Kidney transplant: a mere stage of CKD?]. / Il trapianto è uno stato di malattia renale?

At present, renal transplantation is the best treatment for end-stage renal disease but not the cure. The main factors limiting a full recovery after transplantation include the need for lifelong immunosuppressive therapy (which may lead to severe side effects in the long term), and only partial recovery of renal function after grafting. The latter event is not infrequent nowadays due to the increasing age of donors, who frequently die of cerebrovascular accidents and may have subclinical renal vascular lesions despite a GFR >60 mL/min, with increased susceptibility to calcineurin inhibitor toxicity. As a consequence, uremic alterations such as anemia, arterial hypertension and bone disease may persist at various degrees after surgery and affect the patients' outcome in the long term. The outcome of renal transplantation may be improved if, in addition to accurate tuning of immunosuppressive regimens, we take into account the prevention and treatment of all conditions that may impair the clinical course of transplant recipients.