Chronic Allograft Nephropathy (CAN) refers to a progressive renal insufficiency occurring in renal allografts that is a leading cause of long term graft loss. The pathologic features are nonspecific but appear secondary to a vasculopathy. Early recognition with aggressive management can help preserve the remaining renal function.


The cause appears to be multifactorial, due to a combination of one or more of the following:

(1) nephrotoxicity from cyclosporine, tacrolimus or other drug

(2) chronic low grade rejection

(3) suboptimal allograft

(4) atherosclerotic risk factors (dysplipidemia, hypertension, diabetes mellitus)

(5) poor perfusion


Criteria for the diagnosis of CAN:

(1) absence of other diagnosis (diagnosis of exclusion)

(2) deterioration in glomerular filtration rate (GFR)

(3) significant proteinuria (may be in the nephrotic range)

(4) hypertension

(5) nonspecific pathologic changes (interstitial fibrosis, tubular atrophy, vascular sclerosis, etc.)


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