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- Allograft kidney with acute cellular rejection and atypical glomerular changes under EM
| 姓 名： | ××× | 性别： | Female | 年龄： | 61 |
| 标本名称： | |||||
| 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
×参考诊断
Banff 97肾移植排斥反应活检诊断标准
急性排斥反应1B 活检肾组织间质内明显的炎性浸润（炎性浸润范围波及25%的肾实质组织），并有单个或少许肾小管呈中度的小管上皮炎（单个肾小管横截面或10个肾小管上皮细胞围成的管腔上有＞10个单个核细胞浸润）
慢性移植肾肾病 2级（中度） 中度肾组织间质纤维化和肾小管萎缩
C4d免疫酶组织化学染色阳性
C4d免疫酶组织化学染色阳性
Banff2005移植肾活检诊断标准
慢性活动性抗体介导性排斥反应， 肾小球毛细血管基底膜双轨和/或肾小管周毛细血管基膜多层和/或肾间质纤维化/肾小管萎缩/动脉内膜纤维性增生，C4d+
慢性活动性抗体介导性排斥反应，
肾小球毛细血管基底膜双轨和/或肾小管周毛细血管基膜多层和/或肾间质纤维化/肾小管萎缩/动脉内膜纤维性增生，C4d+
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.
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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.
