Kidney Allograft Fibrosis: Diagnostic and Therapeutic Strategies

Transplantation. 2021 Oct 1;105(10):e114-e130. doi: 10.1097/TP.0000000000003678.


Interstitial fibrosis with tubule atrophy (IF/TA) is the response to virtually any sustained kidney injury and correlates inversely with kidney function and allograft survival. IF/TA is driven by various pathways that include hypoxia, renin-angiotensin-aldosterone system, transforming growth factor-β signaling, cellular rejection, inflammation, and others. In this review, we will focus on key pathways in the progress of renal fibrosis, diagnosis and therapy of allograft fibrosis. This review discusses the role and origin of myofibroblasts as matrix producing cells and therapeutic targets in renal fibrosis with a particular focus on renal allografts. We summarize current trends to use multiomic approaches to identify new biomarkers for IF/TA detection and to predict allograft survival. Furthermore, we review current imaging strategies that might help to identify and follow-up IF/TA complementary or as alternative to invasive biopsies. We further discuss current clinical trials and therapeutic strategies to treat kidney fibrosis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Atrophy
  • Biomarkers / metabolism
  • Biopsy
  • Diet, Healthy*
  • Fibrosis
  • Graft Survival / drug effects*
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Kidney Diseases / diagnosis*
  • Kidney Diseases / etiology
  • Kidney Diseases / metabolism
  • Kidney Diseases / therapy*
  • Kidney Transplantation / adverse effects*
  • Kidney Tubules / diagnostic imaging
  • Kidney Tubules / drug effects*
  • Kidney Tubules / metabolism
  • Kidney Tubules / pathology
  • Predictive Value of Tests
  • RNAi Therapeutics* / adverse effects
  • Renal Agents / adverse effects
  • Renal Agents / therapeutic use*
  • Risk Factors
  • Signal Transduction
  • Treatment Outcome


  • Biomarkers
  • Immunosuppressive Agents
  • Renal Agents