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U0 7 - 1845. #844043110 54 y.o. male Deceased donor renal transplant April 18/06 (APCKD) Creat 120  170  515 Being treated for CMV Rejection?. 54 yrs old male Status post deceased donor renal transplant (April 2006) baseline SCr 100-120 He had ESRD secondary to APCKD.

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U0 7 - 1845

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U0 7 1845

U07-1845

#844043110

  • 54 y.o. male

  • Deceased donor renal transplant April 18/06 (APCKD)

  • Creat 120  170  515

  • Being treated for CMV

  • Rejection?


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  • 54 yrs old male

  • Status post deceased donor renal transplant (April 2006) baseline SCr 100-120

  • He had ESRD secondary to APCKD.

  • CMV D /R, EBV D/ R, Mismatch HLA antigens

  • Medications:

    • Cellcept,Tacrolimus, prednisone

  • Past history:

    • Legally blind (retinitis pigmentosa),

    • HTN

    • Dyslipidemia


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  • 2-3 weeks ago developed leukopenia, Cellcept dose decreased

  • No change in U/O

  • Jan 13 2007 CMV PCR 23,950 copies/ml (peak 55,000 copies/ml)

  • 18 Jan started on Gancyclovir, 26 Jan SCr 140 next day 178 then 2 days 515

  • Hb 105 plate 203 WBC 5.5 LDH normal Bilirubib 11

  • U/A: +3 protein , +1 Hb


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  • Doppler u/s: no diastolic flow, patent renal vein

  • U/S: no hydronephrosis

  • Renal scan: severely impaired perfusion


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IF

  • IgG-Negative.

  • IgA-Negative.

  • IgM- Mild to moderate mesangial staining. Moderate vascular staining.

  • C3- Moderate vascular staining including peritubular capillaries.

  • C1q-Negative.

  • Kappa-Negative.

  • Lambda- Mild vascular staining.

  • Fibrinogen- Moderate interstitial staining. Moderate staining of thrombi in peritubular capillaries and glomerular capillaries.

  • Albumin-Negative.


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IgM


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C3


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C3


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lambda


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fibrinogen


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fibrinogen


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fibrinogen


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IF

  • C4d: Moderate linear peritubular capillary staining. Mild to moderate endothelial staining in small arteries.


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C4d


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C4d


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C4d


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EM

  • Is pending


Diagnosis renal biopsy

DiagnosisRenal Biopsy:

  • Probable antibody-mediated rejection with thrombotic microangiopathy manifested

    • in glomeruli with extensive glomerular capillary thrombosis

    • and congestion and thrombosis in peritubular capillaries.

  • No evidence of T-cell mediated rejection.

  • Banff scores:

    • G0 CG0 I0 CI0 T0 CT0 V0 CV1 AH0 MM0 PTC0


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