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- Allograft kidney with acute cellular rejection and atypical glomerular changes under EM
| 姓 名： | ××× | 性别： | Female | 年龄： | 61 |
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| 简要病史： | The patient is a 61-year-old female with past medical history of end-stage renal disease secondary to polycystic kidney disease status post deceased donor allograft in 2006, with history of hypertension, nonischemic cardiomyopathy. | ||||
| 肉眼检查： | |||||
The formalin fixed specimen was sent to an outside institution for coverage while I was out of
town. The paraffin section diagnosis is as follows:
Allograft kidney, needle biopsy:
A. Mild to moderate acute cellular rejection, B
B. Moderate chronic allograft nephropathy, with focal and segmental glomerulosclerosis involving two of five glomeruli (2/5).
C. Peritubular capillary inflammation; the formalin fixed tissue section shows DIFFUSE C4d staining in the peritubular
capillaries.
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本帖最后由 于 2010-01-13 01:16:00 编辑
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本帖最后由 于 2010-02-06 11:04:00 编辑
I brought this case to the conference and shared it with nephrologists and nephrology fellows. Based on the C4d results and EM finding, acute antibody mediated rejection should be the first diagnosis. After treatment, patient's creatinine is back to under 1.0.
Thank all of you for your comments. I don't have ready answer for this case. But in my report I made diagnosis of chronic transplant glomerulopathy. and list MPGN as differential diagnosis. I am not satisfied with my own diagnosis.
Becuase this case was triaged as transplant kidney, no immunofluorescence microscopy was performed Also this case was sent to an outside institution for coverage while I was out of town. Thus, I don't have paraffin block. Only EM was performed in house. Further study is impossible.
My other differentitial diagnosis is chronic thrombotic microangiopathy or isolated thrombotic microangiopathy. But these are not well established entities.
