First sign/symptom of renal graft rejection is?-

On the basis of the time course and morphology of rejection reactions, they have been classified as hyperacute, acute, and chronic Chronic RejectionPatients present with chronic rejection late after transplantation (months to years) with a progressive rise in serum creatinine levels (an index of renal function) over a period of 4 to 6 months. Chronic rejection is dominated by vascular changes, interstitial fibrosis, and loss of renal parenchyma; there are typically only mild or no ongoing cellular parenchymal infiltrates. The vascular changes occur predominantly in the aeries and aerioles, which exhibit intimal smooth muscle cell proliferation and extracellular matrix synthesis. These lesions ultimately compromise vascular perfusion and result in renal ischemia manifested by loss or hyalinization of glomeruli, interstitial fibrosis, and tubular atrophy. The vascular lesion may be caused by cytokines released by activated T cells that act on the cells of the vascular wall, and it may be the end stage of the proliferative aeritis described earlier. Ref: Robbins Basic Pathology 9TH edition pg no 138