”Subclinical rejection” refers to rejection without any clinical manifestations, and is the most common cause of chronic transplant kidney failure. During this period, the kidney transplant recipient does not have any uncomfortable symptoms, no creatinine and urea nitrogen elevation, no change in urine volume, no weight gain …… This is a kind of unconscious transplant kidney lesion, this quiet slow process, quite some creeping ghosts into the village. Yes, the consequences are just like the ghosts have really entered the village, and when you are alarmed, it is already too late. Currently, the most common type of rejection that causes transplanted kidney lesions and eventually leads to the loss of kidney function is “subclinical rejection”. Because of its extremely insidious nature, it is more dangerous for kidney transplant recipients and must be taken seriously! Unauthorized drug reductions: the secret revelation at the edge of the cliff What exactly causes this underlying pathological process in the transplanted kidney? The main cause of “subclinical rejection” is the insufficient dosage of immunosuppressive drugs. For example, inadequate doses of cyclosporine and FK506, and low doses of primaquine or mif, may cause mild lymphocytic infiltration inside the transplanted kidney, although they do not cause severe acute rejection. These infiltrating lymphocytes can attack the transplanted kidney directly or through secreted cytokines, which can damage the health of the transplanted kidney. Because the kidney has a good reserve capacity, the general damage is not enough to cause an increase in creatinine and urea nitrogen, so at the beginning, people tend to ignore these unnoticeable damages, and even think they are right to reduce the medication, and secretly rejoice in their own cleverness of reducing the medication without permission. These situations can also happen to some “veteran” kidney transplant recipients, and this “self-gratification” is not scientific, just like dancing on the edge of the precipice, which can lead to a devastating disaster at any time! What is the real danger of “subclinical rejection”? ”Subclinical rejection” may not have any obvious clinical symptoms in the short term, but this apparent stability is only temporary, those subtle changes quietly occur, in the months or even years of time, the baby transplanted kidney inflammatory cells and inflammatory factors continue to attack the transplanted kidney day and night, night and day, slowly Resulting in the transplanted kidney starting to develop fibrosis, followed by glomeruli and small blood vessels in the kidney starting to show glass-like changes and gradual thickening of the tubular basement membrane …… These changes above will eventually cause a decrease in the transplanted kidney’s ability to excrete metabolic wastes, triggering a collapse – the transplant The kidney function decreases, resulting in elevated creatinine and urea nitrogen. Sadly, by the time this point is reached, most of them are already powerless to return, and it is too late to regret the accumulation. How to ensure the healthy life of the transplanted kidney How to avoid “subclinical rejection” and maintain the healthy survival of the transplanted kidney? Remember, the most important thing to protect the transplanted kidney is not to reduce the medication without authorization. Any reduction of medication should be done carefully under the guidance of professional doctors, and close follow-up should be maintained, and any changes should be reported to the doctor immediately for early treatment. Since “subclinical rejection” is extremely hidden and difficult to detect clinically, the earlier it is detected, the better the treatment effect will be. In recent years, we have gradually promoted the use of procedural transplantation kidney puncture biopsy for early detection of potential lesions. It has been proved that procedural biopsy is the most reliable and direct diagnostic method to unveil the hidden veil of “subclinical rejection”, and many kidney transplant recipients in the renal transplantation department of Zhongshan Hospital of Fudan University in Shanghai have been detected early through the method of puncture biopsy. Many kidney transplant recipients in the renal transplantation department of Zhongshan Hospital of Fudan University in Shanghai have been treated in a timely manner by puncture biopsy to detect “subclinical rejection” early and obtain more ideal treatment results. Of course, people will worry whether the kidney puncture biopsy will affect the function of the transplanted kidney and whether it will lead to complications such as bleeding, but according to the clinical practice of the kidney transplantation department of Zhongshan Hospital of Fudan University in Shanghai and the experience of hundreds of thousands of kidney transplant recipients worldwide, it has been proved that the kidney puncture biopsy is a fairly safe means of transplantation health examination, and the related effects on the transplanted kidney are minimal. It is safe for transplant recipients to undergo. Conclusion Subclinical rejection due to underdose is the most common cause of chronic transplant kidney failure, but as long as we remain vigilant, do not reduce medication arbitrarily, maintain close contact with the doctor, and overcome the fear of transplant kidney puncture biopsy, we can avoid such a dilemma of dancing on the edge of the cliff and ensure the long-term health of the transplanted kidney. healthy life.