Study of the Spectrum of Pathological Findings in Renal Transplant Recipients with an Asymptomatic Slow Rise in Serum Creatinine at a Tertiary Care Centre in North India

Niranjan Gogoi *

Department of Nephrology, SMS Medical College, Jaipur, Rajasthan, India.

Megha Agarwal

Department of Nephrology, Mahatma Gandhi College Jaipur, Rajasthan, India.

Arjun Agarwal

Department of Nephrology, SMS Medical College, Jaipur, Rajasthan, India.

Rakesh Gupta

Department of Nephrology, SMS Medical College, Jaipur, Rajasthan, India.

Dhananjai Agarwal

Department of Nephrology, SMS Medical College, Jaipur, Rajasthan, India.

*Author to whom correspondence should be addressed.


Background: Chronic allograft dysfunction, characterized by a progressive increase in serum creatinine levels after kidney transplantation, poses a significant challenge in renal transplant recipients.

Aim: This study aimed to assess the spectrum of pathological findings in renal transplant recipients with an asymptomatic slow rise in serum creatinine.

Methodology: A hospital-based cross-sectional study was conducted, including patients who underwent kidney transplantation and exhibited a creeping rise in creatinine within 3 months to one year. Renal biopsies were performed, and the samples were analysed using various techniques.

Results: Among 30 patients included in the study, a high prevalence of acute tubular necrosis20%(n=6), active antibody-mediated rejection20%(n=6),chronic active antibody-mediated rejection20%(n=6), chronic allograft injury10%(n=3), chronic T cell-mediated rejection10%(n=3), acute cellular rejection10%(n=3), membranous nephropathy(n=1), C3 glomerulonephritis(n=1), and cortical necrosis(n=1) was observed. The timing of biopsy post-transplantation and donor HLA mismatch were also evaluated.

Conclusion: These findings emphasize the importance of early detection and proper management of pathological conditions contributing to chronic allograft dysfunction to improve long-term outcomes following kidney transplantation.

Keywords: Chronic allograft dysfunction, renal transplant, serum creatinine, graft failure

How to Cite

Gogoi, N., Agarwal , M., Agarwal , A., Gupta, R., & Agarwal , D. (2024). Study of the Spectrum of Pathological Findings in Renal Transplant Recipients with an Asymptomatic Slow Rise in Serum Creatinine at a Tertiary Care Centre in North India. International Journal of Advances in Nephrology Research, 7(1), 1–6. Retrieved from


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Marta Lidia Monteverde et al: Donor-specific anti-HLA antibodies in pediatric renal transplant recipients with creeping creatinine: Prevalence, histological correlations, and impact on patient and graft survival; 2015 DOI: 10.1111/petr.12556

Mihatsch MJ, Thiel G, Ryffel B. Histopathology of cyclosporine nephrotoxicity. Transplant Proc. 1988;20:7 59-771.

Mihatsch MJ, Ryffel B, Gudat F. The differential diagnosis between rejection and cyclosporine toxicity. Kidney Int Suppl. 1995;52:S63-S69.

Paul LC, Hayry P, Foegh M, et al. Diagnostic criteria for chronic rejection/accelerated graft atherosclerosis in heart and kidney transplants: Joint proposal for the fourth alexis carrel conference on chronic rejection and accelerated arteriosclerosis in transplanted organs. Transplant Proc. 1993;25:2022.

Toledo Pereyra-LH, Whitten JI. Compa¬rison of the incidence and effect of ATN in the cyclosporine and ALG eras. Transplant Proc. 1988;20:910-2.

Chung YC, Huang MT, Chang CN, Lee PH, Lee CS, Huang TW. Prolonged nonoliguric acute renal failure associated with high-dose vitamin K administration in a renal transplant recipient. Transplant Proc. 1994;26:2129-31.

Canadian Multicentre Transplant Study Group. A randomized clinical trial of cyclosporine in cadaveric renal transplantation. New Eng J Med. 1983; 309:809-15. DOI: 10.1056/NEJM198605083141904

Civantos DP, Cantero AM, Marcos MR, Seijas HF, Triviño MS, Frutos MP, et al. Utility of basal regional oximetry saturation for the diagnosis of acute tubular necrosis in the early postoperative period following kidney transplantation. Transplant Proc. 2019;51:328-33.

Chung YC, Lee PH, Hu RH. The outcome and delayed graft function in cadaveric renal transplants treated with low dose cyclosporine. J Formos Med Assoc. 1991; 90:975-80.

Toussaint C, Kinnaert P, De Pauw L. Comparison of low doses of cyclosporine with azathioprine immunosuppression during the first year following transplantation. Transplant Proc. 1986;18: 1256-8.

Ruggenenti P, Perico N, Mosconi L, Gaspari F, Benigni A, Amuchastegui CS, et al. Calcium channel blockers protect transplant patients from cyclosporine-induced daily renal hypoperfusion. Kidney Int. 1993;43(3):706-11. DOI: 10.1038/ki.1993.101

Palmer BF, Dawidson IN, Sagalowsky AR, Sandor ZS, Lu CY. Improved outcome of cadaveric renal transplantation due to calcium channel blockers. Transplantation. 1991;52:640- 5.

DOI: 10.1097/00007890-199110000-00012

Orandi BJ, Chow EH, Hsu A, Gupta N, Van Arendonk KJ, Garonzik‐Wang JM, Montgomery JR, Wickliffe C, Lonze BE, Bagnasco SM, Alachkar N. Quantifying renal allograft loss following early antibody‐mediated rejection. American journal of transplantation. 2015;15(2):489-98.

Gloor JM, Cosio FG, Rea DJ, Wadei HM, Winters JL, Moore SB, DeGoey SR, Lager DJ, Grande JP, Stegall MD. Histologic findings one year after positive crossmatch or ABO blood group incompatible living donor kidney transplantation. American Journal of Transplantation. 2006;6(8):18 41-7.

Bentall A, Cornell LD, Gloor JM, Park WD, Gandhi MJ, Winters JL, Chedid MF, Dean PG, Stegall MD. Five‐year outcomes in living donor kidney transplants with a positive crossmatch. American Journal of Transplantation. 2013;13(1):76-85.

Thomas KA, Valenzuela NM, Reed EF. The perfect storm: HLA antibodies, complement, FcγRs, and endothelium in transplant rejection. Trends in Molecular Medicine. 2015;21(5):319-29.

Wiebe C, Pochinco D, Blydt-Hansen TD, Ho J, Birk PE, Karpinski M, Goldberg A, Storsley LJ, Gibson IW, Rush DN, Nickerson PW. Class II HLA epitope matching—a strategy to minimize de novo donor-specific antibody development and improve outcomes. American Journal of Transplantation. 2013;13(12):3114-22.

Geneugelijk K, Hönger G, Van Deutekom HW, Thus KA, Keşmir C, Hösli I, Schaub S, Spierings E. Predicted indirectly recognizable HLA epitopes presented by HLA-DRB1 are related to HLA antibody formation during pregnancy. American Journal of Transplantation. 2015;15 (12):3112-22.

Sigdel TK, Sarwal MM. Moving beyond HLA: A review of nHLA antibodies in organ transplantation. Human immunology. 2013;74(11):1486-90.

Gaston RS, Cecka JM, Kasiske BL, Fieberg AM, Leduc R, Cosio FC, Gourishankar S, Grande J, Halloran P, Hunsicker L, Mannon R. Evidence for antibody-mediated injury as a major determinant of late kidney allograft failure. Transplantation. 2010;90(1):68-74.

Miettinen J, Peräsaari J, Lauronen J, Qvist E Valta H, Pakarinen M, Merenmies J, Jalanko H. Donor-specific HLA antibodies and graft function in children after renal transplantation. Pediatric Nephrology. 2012;27:1011-9.