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Currently filtering by tag: Antibody Mediated Rejection

Diagnose This (January 12, 2021)

Article
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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Diagnose This (August 5, 2019)

Article
mesangiolysis, renal pathology, kidney biopsy stain, arkana laboratories
What is this finding in this native kidney?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​...
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Twitter Poll (February 20, 2019)

Article
Antibody-Mediated Rejection, Twitter Poll, Arkana Laboratories
ANSWER: B The findings are suspicious for active antibody-mediated rejection (ABMR), based on the presence of moderate glomerulitis (g2), severe peritubular capillaritis (ptc3) and C4d staining in PTCs (C4d2). Serologic evidence of DSA is advised in order to meet the criteria for diagnosis. Reference: Haas M, et al. The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T-cell mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant. 2018; 1-15.
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Chronic Active Antibody-Mediated Rejection

Article
A diagnosis of chronic active antibody-mediated rejection (ABMR) requires morphologic evidence of chronic tissue injury (e.g. transplant glomerulopathy), evidence of current or recent antibody interaction with the vascular endothelium (e.g. linear C4d staining of peritubular capillaries), and serologic evidence of donor specific antibody (DSA) formation.  Importantly, the revised 2017 Banff classification of ABMR and T cell-mediated rejection (TCMR) recognizes C4d positivity as a substitute for DSA for diagnosing ABMR, although DSA testing is still strongly encouraged (see reference).  The images are from a patient with an elevated serum creatinine who had undergone living unrelated kidney transplant four years ago.  The...
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Diagnose This! (March 19, 2018)

Article
What is your diagnosis in this renal transplant biopsy?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​...
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Diagnose This! (February 19, 2018)

Article
What is your diagnosis in this renal transplant patient?     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​    ...
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Pushing Glass (October 10, 2017)

Article
The patient is a 50-year-old African-American female with a past medical history significant for ESRD secondary to lupus nephritis who presents two weeks after a renal transplant with a delay in graft function. Her creatinine at the time of presentation is 9. She reports feeling fine and does not have any rashes or joint discomfort. A renal biopsy is performed on the transplanted kidney. Which is the best diagnosis? A. Acute Tubular Injury B. Thrombotic thrombocytopenic purpura C. Acute Antibody-Mediated Rejection D. Vasculitis  The correct answer is c (acute antibody-mediated rejection). The biopsy shows a constellation of findings. This includes...
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Chronic Transplant Arteriopathy

Article
This image shows an arterial cross-section with features of chronic transplant arteriopathy (a.k.a. “sclerosing transplant vasculopathy” and “chronic allograft vasculopathy”). The lesion is characterized by fibrous intimal thickening of the arterial wall with lymphocytes (usually T-cells) and monocytes/macrophages within the thickened intima. Unlike some arteriosclerotic lesions in patients with hypertension, the arterial wall in chronic transplant arteriopathy lacks prominent accumulation of elastic fibers. Given the presence of mononuclear cells in the vessel wall, one must carefully search for endothelialitis. If found, a diagnosis of active vascular rejection, antibody-mediated rejection or acute T-cell-mediated rejection, should be considered.
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