Chronic transplant nephropathy is a disorder that occurs in numerous cases after kidney transplantation. The condition is also referred to by its short form, CTN, and often results in loss of kidney function in the transplanted organ.
What is chronic transplant nephropathy?
Chronic graft nephropathy is comparatively common in the setting of kidney transplantation. Biopsies show that between 40 and 60 percent of patients have signs of the disease two years after organ transplantation. The phenomenon occurs in numerous cases even when the transplanted organ is very well accepted by the person’s organism. Chronic graft nephropathy is the most important reason for the need for dialysis again in people who have received a donor organ. In addition, chronic graft nephropathy is a common cause of ultimate renal failure in developed countries.
Causes
The causes of the development of chronic graft nephropathy are very complex and currently not conclusively understood. To date, several causes of the disease are known to be interrelated. The main causes are immune recognition, inflammatory processes and stress caused by organic injuries. The development of the disease takes place in a spectrum between these three factors. So-called calcineurin inhibitors are particularly relevant for the development of chronic graft nephropathy. These are mainly significant for those processes of disease genesis that are not related to immune recognition. Possible influences in this area are, for example, proteinuria and various infections. In addition, the quality of the donor kidney and its age play an important role. Other favoring factors consist of elevated blood pressure, ischemic lesions of the kidney due to transplantation, and cigarette consumption. Chronic graft nephropathy is more often seen in transplanted kidneys taken from dead rather than living donors. However, the progression of the disease as well as its symptoms are nearly identical in both origins.
Symptoms, complaints, and signs
Chronic graft nephropathy is manifested by a number of typical signs of disease. As the disease progresses, the filtering capacity of the transplanted kidney steadily declines. This process of deterioration extends over a period of several months to several years. As a result of the decreasing and eventually failing filtering capacity of the kidney, a final and complete loss of kidney function results. This renal failure affects not only the transplanted organ itself, but also the diseased patient’s own two kidneys.
Diagnosis and progression
Chronic transplant nephropathy can be diagnosed by a variety of specialists. However, in the majority of cases, a physician who was also involved in the kidney transplantation or who is responsible for follow-up makes the diagnosis of the disease. In many cases, chronic transplant nephropathy is discovered during the regular check-ups that patients with donor kidneys undergo. In particular, blood tests of the diseased persons play an important role. The blood is analyzed in the laboratory, and special markers are checked. In the case of chronic transplant nephropathy, this usually already reveals indications of the presence and progression of the disease. In addition, there are further options for the examination and diagnosis of chronic graft nephropathy. In the course of a biopsy, tissue is taken from the organ and examined in the laboratory. In the process, physicians detect chronic impairment of the kidney’s function. Characteristic signs of the disease include pathologically enlarged connective tissue and damage to the corpuscles and tubules of the organ. As a result of inflammatory processes, the thickness of the walls of the blood vessels increases. As a result, the so-called lumen narrows. However, the exact cause of the decreasing filtering capacity of the kidney is often not identifiable during the diagnostic process.In addition to chronic graft nephropathy, immune system-induced rejection of the donor organ may also be a trigger for the symptoms.
Complications
Transplant nephropathy usually results in relatively serious complications because the transplanted kidney does not function properly in the body. Various symptoms and complications occur, most of which clearly point to renal insufficiency. However, the performance of the kidney may also decrease only over the years and not lead to complaints right at the beginning. In the worst case, the complete failure of the kidney without treatment can lead to death. The affected person is then dependent on dialysis. In most cases, transplant nephropathy is first treated with medication. However, no positive course of the disease can be gratinated. Whether kidney function can be preserved also depends greatly on the patient’s physical condition. As a rule, a healthy lifestyle also has a positive effect on graft nephropathy and can limit or prevent it. Excess weight must also be reduced. Unfortunately, a causal treatment of graft nephropathy is not possible. If the treatment is unsuccessful, the affected person is dependent on dialysis. This also reduces life expectancy.
When should one go to the doctor?
In most cases, this complaint occurs when the affected person is still in the hospital. For this reason, diagnosis and treatment can be initiated immediately. A medical examination must be performed when the affected person’s kidney is not functioning. The loss of function does not have to occur immediately, but can extend over several months or years. For this reason, the patient is dependent on regular examinations after the transplantation in order to avoid further complications. Since this can also damage the patient’s own kidney, this kidney must also be checked. As a rule, an internist or the doctor treating the kidney transplant can be contacted in the case of this disease. Treatment is then given by taking medication. However, the affected person is still dependent on a donor organ. In case of possible psychological complaints or depression, a psychologist should be consulted. It is also possible that the disease significantly reduces the life expectancy of the affected person.
Treatment and therapy
To treat the disease, the attending physician prescribes various curative measures. Chronic graft nephropathy is primarily treated with medication. In addition, the patient is encouraged to make positive lifestyle changes. Initially, affected individuals receive immunosuppressive agents that do not show the effect of calcineurin inhibitors. In this way, the progression of chronic graft nephropathy may be delayed. In principle, however, no specific treatment for chronic graft nephropathy exists to date. Instead, it is the responsibility of patients to reduce certain risk factors in their own lifestyle. Excess weight should be reduced if possible, and smoking should also be stopped. Ideally, blood pressure should be in a low to optimal range. Certain ACE inhibitors sometimes have a beneficial effect on the excretion of proteins. Patients are prescribed to take these agents as adjunctive treatment for chronic graft nephropathy. Medical research studies are currently underway to specifically prevent and treat chronic transplant nephropathy. This is because it also reduces the waiting time of dialysis patients for a donor kidney.
Outlook and prognosis
The prognosis of chronic graft nephropathy is highly individualized, but it is considered unfavorable in many cases. Although the number of affected patients has decreased significantly over the past decades, graft nephropathy leads to a severe deterioration of health or, in the worst case, to the patient’s death. The prospect of recovery is higher in patients with a donor kidney from a living person than from a donor who has already died. Additional psychological factors are important for recovery.The patient’s current stress experience or possible psychological impairments have a significant influence on the further course of the disease. If the patient is in emotional balance, his prognosis improves. With a healthy lifestyle and a stable psyche, the existing complaints often decrease. If the patient does not manage to reduce the risk factors, further deterioration usually occurs. In the worst case, the donor kidney may be rejected or organ failure may occur. This puts the patient’s life at risk again. Because patients with a donor kidney have faced many challenges in the past, they often lack the optimism necessary to cope with chronic graft nephropathy when donor kidney complications occur.
Prevention
Effective prevention of chronic transplant nephropathy on the part of patients is possible only to a limited extent. In this regard, a lifestyle that is as healthy as possible makes an important contribution to reducing the risk of chronic graft nephropathy. However, chronic graft nephropathy is also possible in individuals without obesity or tobacco use.
Follow-up
Chronic graft nephropathy occurs as a result of an implanted donor kidney. It results in premature failure of the implanted organ and must be treated promptly. Regular visits to the doctor are therefore mandatory for patients with implants. Without medical follow-up and constant monitoring, no kidney can be transplanted. In the past, the high number of patients in whom a kidney transplant patient developed chronic graft nephropathy after only two years was problematic. In up to 60 percent of those implanted, this diagnosis was made by biopsy. In most cases, this meant that the patient with kidney disease had to undergo dialysis again. The discomfort required regular medical care to ensure that the donor kidney was preserved for as long as possible. Everything that is done medically in this sense is part of the aftercare. In part, the classical immunosuppressants administered were responsible for the development of chronic graft nephropathy. The reason is their toxicity, which is especially damaging to the kidneys. The treating physicians therefore nowadays often prescribe a different immunosuppressant that is less toxic to the kidneys. This has reduced the number of patients with chronic transplant nephropathy. Because kidney transplantation is a major intervention in the body, follow-up care must be correspondingly extensive. Otherwise, the transplanted detoxification organ can no longer fulfill its tasks within a few years.
What you can do yourself
Because chronic transplant nephropathy is a side effect of a surgical procedure, the affected person himself has few options for self-help. Nevertheless, he or she can exert an overall influence for the preservation of his or her enjoyment of life and quality of life in order to achieve an improvement in his or her well-being. The disease occurs quite frequently with a kidney transplant. This gives the affected person the opportunity to exchange information with other sufferers and to benefit from their experiences. It is always helpful for the healing process if a healthy lifestyle is lived. This includes a daily routine that is as regular as possible, good sleep hygiene and a healthy diet. The immune system should be strengthened so that the organism does not become susceptible to pathogens. Excess weight should be avoided, as should nicotine, alcohol and other drugs. Knowing one’s own physical limits helps to be able to take rest periods in time. A stable social environment and participation in social life are also important to promote quality of life. Mental health should be promoted with leisure activities, an optimistic outlook on life and confident thoughts. Mental relaxation techniques can help strengthen the mind and keep a sense of humor. It helps to address fears openly and, if necessary, to seek therapeutic help.
