学习，谢谢quhong老师

 The final diagnosis is worded as following: acute tubular necrosis-like changes with positive C4d stain in peritubular capillaries, suggestive of acute antibody-mediated rejection, type I (Banff Classification 2005). There is focal interstitial mononuclear cell infiltration. It is focal, without tubulitis. It is not enough for the diagnosis of concurrent "borderline changes suspicious for acute T-cell-mediated rejeciton".

A definitive diagnosis of acute antibody mediated rejection requires: 1) morphologic evidence of acute tissue injury, 2) immunopathologic evidence for antibody action, and 3) serologic evidence of circulatingdonor-specific antibodies.  If only two of three criteria are present, such a case should be considered "suspicious for or suggestive of" acute antibody-mediated rejection.

In this case, the glomerulus is unremarkable. In the photo #2 and #3, there are lymphoid cells or moncytes in peritubular capillaries. This type of change is often seen in actue antibody-mediated rejection.

 肾小球系膜基质增生,间质灶状炎细胞浸润,少量肾小管有炎细胞浸润,部分间质水肿,呈轻微急排表现.          

部分肾小管萎缩 .

不知道免疫组化染的是什么抗体,如果是c4d. 阳性的话就要考虑体液性排斥.

 从切片上看：肾小球系膜基质增生。间质灶状炎细胞浸润。肾小管上皮细胞部分脱落，管腔内少量炎细胞浸润。能否提供更详细的病史，及免疫检查。个人意见

 没遇见过，希望听到楼主讲解，谢谢。

 

以下是引用小荷在2009-4-23 23:44:00的发言：  很漂亮，不会看

Me too. I forget renal disease pathology already. This is true beautiful photos.

 很漂亮，不会看