楼主 发表于 2009-05-07 20:13|举报|关注(0)

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姓    名：	×××	性别：		年龄：
标本名称：
简要病史：	肾移植术后4月，肌酐轻度升高，移植肾穿刺活检
肉眼检查：

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添加参考诊断

1 楼    发表于2009-05-07 20:29:00举报|引用

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 11

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

名称：图5
描述：图5

名称：图6
描述：图6

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2 楼    发表于2009-05-13 20:52:00举报|引用

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There is scattered interstitial mononuclear cell infiltration. But it is not much in these photos. Tubulitis is seen, probably at the level of t2. Glomerulitis is also present.  Whether there is interstitial edema is not sure. Let's assume the interstitial mononuclear cell infiltration involves more than 25% of the cortical tissue. These findings are enough for the diagnosis of acute T-cell-mediated rejection, at least Banff type 1A. The changes of the small arteries or arterioles are subtle. In the photo #4, the arteriolar wall shows somewhat fibrinoid change, without cellular response. I am not sure if it is a true fibrinoid necrosis or artifact.  It is too pink for hyalinosis. In the photo #5 and #6, the small arteries have unusual appearance. But I cannot name it. The better place to look for arteritis is the artery with internal elastic lamina. A transplant kidney biopsy without single artery with internal elastic lamina is inadequate sample. Overall, this is Banff 1A rejection at least, maybe higher type.  Do you routinely do C4d stain? Please let's know your diagnosis and your patient's response to the treatment.

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3 楼    发表于2009-05-15 14:04:00举报|引用

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 抱歉：病史发错了！

肾移植术后5年，移植肾穿刺活检

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4 楼    发表于2009-05-15 14:05:00举报|引用

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1。移植肾疑为急性排斥反应（suspicious of acute rejection, Banff97 Schema, i1,t1,g0,v0,ah0）。少数肾小球入球动脉管壁局部透明样变，请临床结合血压排除高血压因素。

          2．移植肾慢性移植肾肾病I级（chronic allograft nephropathy, CAN, grade I,ci1,ct1,cg2,cv0）。

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5 楼    发表于2009-05-15 21:05:00举报|引用

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 感谢frankbj老师的final diagnosis. I overcalled. 学习中.

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6 楼    发表于2018-02-28 21:43:27举报|引用

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 最近在对照书本学习，谢谢老师提供的病例

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你的潜力埋藏在你的心灵深处，当你发现它时，它会发出万丈光芒。