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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
U07-1845

#844043110

  • 54 y.o. male
  • Deceased donor renal transplant April 18/06 (APCKD)
  • Creat 120  170  515
  • Being treated for CMV
  • Rejection?
slide2
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
slide3
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
slide4
Doppler u/s: no diastolic flow, patent renal vein
  • U/S: no hydronephrosis
  • Renal scan: severely impaired perfusion
slide5
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.
slide13
IF
  • C4d: Moderate linear peritubular capillary staining. Mild to moderate endothelial staining in small arteries.
slide17
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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