Re: Diagnosis of Interstitial Fibrosis and Tubular Atrophy in Kidney Allograft: Implementation of MicroRNAs

Dear Editor, Chronic allograft nephropathy (CAN), like its successor category of interstitial fibrosis/tubular atrophy (IFTA), is a purely descriptive term used to denote the microscopical appearances of chronic sclerosing lesions observed on dysfunctional or surveillance kidney allograft biopsies. However, the widespread use of the term led to a misconception in the minds of many, that it was a specific disease entity. This led to the formal replacement of the term by the Banff classification in its 2005 meeting by the “IFTA, not otherwise specified (NOS)” category. Another important aim of this change was to encourage the transplant pathologists to look for and identify the specific causes of late graft dysfunction on kidney allograft biopsies and not just simply dump all the chronic lesions into the paper wastebasket category of CAN, so as to guide the optimal patient management and improve the long-term graft outcomes. The problems of nomenclature and classification aside, the chronic sclerosing changes are quite frequent on kidney allograft biopsies and form the focus of the current research on kidney allograft pathology.