Table Manifestations of Kidney Transplant Rejection by Category Rejection Category Manifestations Hyperacute Fever, anuria Accelerated Fever, oliguria, graft swelling and tenderness Acute Fever, increased serum creatinine, hypertension, weight gain, graft swelling and tenderness Appearance of protein, lymphocytes, and renal tubular cells in urine sediment Chronic Proteinuria with or without hypertension, nephrotic syndrome Rejection can be diagnosed by percutaneous needle biopsy if the diagnosis is unclear clinically.