Chronic Allograft Rejection

Typical clinical presentation Gradual increase in creatinine (months) Non-nephrotic-range proteinuria No recent nephrotoxic events Key pathologic features Interstitial fibrosis

Arterial fibrosis and intimal thickening

Hypothetical schema for chronic rejection

Acute rejection Antibody deposition Oxidized LDL Infection

T cells Macrophages Platelet aggregates

Cytokines/ growth factors

Cell proliferation Fibrosis

Vascular injury Arteriosclerosis

Tubulointerstitial injury Glomerular sclerosis

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