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Currently filtering by tag: Antibody Mediated Rejection

Diagnose This (August 5, 2019)

What is this finding in this native kidney?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​   ​...

Twitter Poll (February 20, 2019)

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.

Chronic Active Antibody-Mediated Rejection

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...

Diagnose This! (March 19, 2018)

What is your diagnosis in this renal transplant biopsy?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​...

Diagnose This! (February 19, 2018)

What is your diagnosis in this renal transplant patient?     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​    ...

Pushing Glass (October 10, 2017)

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...

Chronic Transplant Arteriopathy

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.

Glomerulitis

This image (Jones silver stain) shows prominent glomerulitis in an allograft kidney biopsy, characterized in this case by increased mononuclear cells and segmental endothelial cell swelling within glomerular capillary loops. The patient is a young adult man who had received a renal transplant approximately eight years ago and was found to have an elevated serum creatinine. In the transplant setting, glomerulitis and peritubular capillaritis represent forms of microvascular inflammation which are used to help establish a morphologic diagnosis of both acute/active and chronic/active antibody-mediated rejection. Reference: Haas M. An updated Banff schema for diagnosis of antibody-mediated rejection in renal allografts....