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- Transplant kidney biopsy
| 姓 名： | ××× | 性别： | Woman | 年龄： | 38 |
| 标本名称： | Allograft kidney, needle biopsy. | ||||
| 简要病史： | Kidney transplant 3 months ago, with elevated creatinine. Prior biopsy showed acute tubular necrosis. | ||||
| 肉眼检查： | Unremarkable. | ||||
名称：图1
描述：图1
名称：图2
描述：图2
名称：图3
描述：图3
名称：图4
描述：图4
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×参考诊断
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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.
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