楼主 发表于 2010-09-01 16:30|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6天，肌酐升高，无尿
肉眼检查：

c4d（-）

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1 楼    发表于2010-09-03 09:32:00举报|引用

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本帖最后由 于 2010-09-03 09:35:00 编辑 Hi, frankbj, it is nice case. Figure 2 shows endoarteritis (v1), which is enough for diagnosis of acute T-cell-mediated rejection, Banff type 2A. Based on Banff system, Banff 2A or 2B or 3 is solely dependent on v1, v2, and v3. Interstitial mononuclear infiltration and tubulitis are not required. Often, interstitial monnuclear infiltration (i) and tubulitis (t) are present. Sometime, i or/and t are so mild (isolated arteritis), which makes our nephrologists uncomfortable to treat patient as 2A or 2B or 3 rejection.

I don't know how to explain the tubular vacuolization in figure 3, 4 and 8. It is not exactly isometric. Let me know your thought.

The hemorrhage reminds me of acute antibody mediated rejection. But the C4d is negative. Therefore, it is better interpreted as part of cellular rejection or procedure-induced bleeding.

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2 楼    发表于2010-09-15 15:22:00举报|引用

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结合C4d免疫组织化学染色呈阴性，初步考虑为急性T细胞介导性排斥反应IIA，另请临床检测血清抗体水平以最终确定抗体介导性排斥反应可能。结合多数肾小管上皮细胞等大和不规则空泡变以及术后6天开始出现无尿，请排除临床应用利尿剂后所致肾小管上皮空泡变可能。

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