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January 12, 2021

Diagnose This (January 12, 2021)

antibody-mediated rejection, arkana laboratories, renal pathology, diagnose this, kidney disease

What are the two major changes seen in this image from an allograft kidney and what are these findings concerning for?

 

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Answer: The light microscopic image of a glomerulus on silver stain demonstrates glomerulitis as characterized by capillary loop occlusion by mononuclear cells and neutrophils along with endothelial enlargement which is concerning for active antibody-mediated rejection. Other features used to diagnose antibody-mediated rejection, in this case, included severe peritubular capillaritis and diffusely positive C4d in peritubular capillaries.  The image also shows chronic changes of antibody-mediated rejection with multiple loops showing double contour formation. For more information on the Banff criteria for transplant rejection, see the following reference:

 

Reference: Loupy A, Haas M, Roufosse C, et al. The Banff 2019 Kidney Meeting Report (I): Updates on and clarification of criteria for T cell– and antibody-mediated rejection. Am J Transplant. 2020; 00: 1–14.