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4 楼 发表于2010-08-04 21:02:00举报|引用
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本帖最后由 于 2010-08-04 21:04:00 编辑
I agree that there is no obvious cellular rejection. The white cell margination in vessels could be secondary change. The tubular necrosis/injury is not proportional to the cellular infiltration. As you mentioned that C4d is focally positive, what about patient's donor specific antibody (DSA)? If DSA is positive, acute antibody-mediated rejection is the differential diagnosis.
The acute tubular necrosis/injury and collapse of glomeruli also suggest ischemia. I had one allograft kidney removed due to dissecting aneurysm at the anastomosis site. Please check renal artery and renal vein (for renal vein thrombosis).
I agree that there is no obvious cellular rejection. The white cell margination in vessels could be secondary change. The tubular necrosis/injury is not proportional to the cellular infiltration. As you mentioned that C4d is focally positive, what about patient's donor specific antibody (DSA)? If DSA is positive, acute antibody-mediated rejection is the differential diagnosis.
The acute tubular necrosis/injury and collapse of glomeruli also suggest ischemia. I had one allograft kidney removed due to dissecting aneurysm at the anastomosis site. Please check renal artery and renal vein (for renal vein thrombosis).
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