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Currently filtering by tag: Glomerulitis

Twitter Poll (February 20, 2019)

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.

Diagnose This! (February 19, 2018)

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

Antibody-Mediated Rejection

This biopsy was performed on a 37-year-old female with a history of type 1 diabetes mellitus, status post second deceased donor renal transplant, who now presents with allograft dysfunction (Cr 3.1 mg/dl) and mild proteinuria (UPC 1.1 g/g). No donor-specific antibody (DSA) data was available at the time of the biopsy. The biopsy shows severe glomerulitis and chronic transplant glomerulopathy (Fig 1), along with mild peritubular capillaritis (Fig 2) and diffusely positive C4d staining in peritubular capillaries (Fig 3). Based on the Banff 2017 kidney meeting report, this case can now be diagnosed as chronic active antibody-mediated rejection, and the...

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...

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....