Table 1:

Common etiologies of failing renal allograft.

	Groups of diseases or conditions	Common diseases or conditions
Non-immunological-related causes
Prerenal causes	• Systemic diseases • Reno-vascular disease	• Orthostatic hypotension commonly in long-standing diabetes mellitus, cardio-renal syndrome
Intrinsic renal causes	• Recurrent native renal disease in a transplant renal allograft • Interstitial disease	• E.g. FSGS, MGN, IgAN, LN • E.g. recurrent transplant pyelonephritis
Post-renal causes	• Transplant nephrolithiasis
Immunological-related causes
Acute renal allograft rejection	• Unintended lowering immunosuppression • Intended lowering immunosuppression	• Non-medication adherence • E.g. Lowering immunosuppression during over immunosuppressed stage when the following complications occur: CMV, BK, GI side effects, malignancy
Chronic renal allograft dysfunction or the old term “transplant glomerulopathy”	• ChronicABMR	• Untreated, inadequately treated, or even unsuccessfully treated acute renal allograft rejections leading to ongoing inflammatory process and ultimately chronic scarring
Immunosuppressive medications	• Chronic CNI nephrotoxicity	• Long-standing exposure to high level of immunosuppressive medications
Opportunistic infection	• BKVAN	• Leading to interstitial disease or post-renal obstruction

ABMR, antibody-mediated rejection

BKVAN, BK virus-associated nephropathy

CMV, cytomegalovirus

CNI, calcineurin inhibitor

FSGS, focal segmental glomerulosclerosis

GI, gastrointestinal

IgAN, immunoglobulin A nephropathy

LN, lupus nephritis