European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.2.1 Differential diagnosis of chronic graft dysfunction.

A. Any significant deterioration in graft function should be investigated using the appropriate diagnostic tools and, if possible, therapeutic interventions should be initiated. The usual causes of a decline in glomerular filtration rate after the first year include transplant-specific causes such as chronic allograft nephropathy, acute rejection episodes, chronic calcineurin inhibitor nephrotoxicity, transplant renal artery stenosis and ureteric obstruction, as well as immunodeficiency-related causes and non-transplant-related causes, such as recurrent or de novo renal diseases and bacterial infections. B. Any new onset and persistent proteinuria of >0.5 g/24 h should be investigated and therapeutic interventions should be initiated. The usual causes include chronic allograft nephropathy and transplant glomerulopathy, and recurrent or de novo glomerulonephritis.