European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.2.4. Chronic graft dysfunction. De novo renal disease after transplantation.

A. Acute pyelonephritis is relatively frequent in the transplanted kidney and carries a risk of septicaemia. The condition should be recognized and the patient should be treated promptly in the hospital. B. After initiation of any drugs known to induce the development of interstitial nephritis in the transplant patient, it is recommended to monitor renal function and abnormalities in order to detect any side effects rapidly. If interstitial nephritis is observed, it is recommended to stop the offending drug, and to initiate appropriate treatment. C. De novo membranous nephropathy should be considered in cases of proteinuria and nephrotic syndrome after transplantation. Viral infection, such as HCV, should be excluded. D. In the case of the development of graft dysfunction in a transplant patient with Alport's syndrome, one should consider additionally the possibility of de novo anti-glomerular basement membrane (anti-GBM) glomerulonephritis.