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U0 7 - 174. #230080120 Original disease DIC. Cad Tx 5 years ago. Creat about 90. Not diabetic. U07-00174 24 year old Asian female meningococcemia at age 17 with purpura fulminans, digital infarcts/amputations, and irreversible ARF

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u0 7 174
U07-174

#230080120

  • Original disease DIC.
  • Cad Tx 5 years ago.
  • Creat about 90.
  • Not diabetic.
slide2

U07-00174

  • 24 year old Asian female
  • meningococcemia at age 17 with purpura fulminans, digital infarcts/amputations, and irreversible ARF
  • deceased donor renal Tx 16 November 2001; 2 yr old pediatric donor
  • 7% flow PRA against class II HLA, negative against class I HLA
  • good initial function
  • maintenance immunosuppression with prednisone, MMF and cyclosporine (2h levels 500-800 µg/L); reduced MMF 500 mg BID due to leukopenia
  • baseline creatinine 80-95 µM
  • creep in creatinine to 95-105 µM through 2006; 114 µM in January 2007
  • normal urinalysis with protein/creatinine ratio 11 mg/mmol in Oct 2005; trace protein in January 2007 (protein/creatinine ratio pending)
  • retrospective flow B cell XM positive against donor at time of Tx; currently stronger. T cell XM also positive ?real. Flow PRA 20-35% against class II.
  • Bx performed which reveals…..
slide3
IF
  • IgG- Mild cytoplasmic staining of interstitial plasma cells.
  • IgA-Negative.
  • IgM- Trivial to mild mesangial staining.
  • C3- Moderate vascular staining.
  • C1q- Mild to moderate patchy granular staining along the periphery of capillary loops.
  • Kappa and Lambda- Moderate numbers of interstitial plasma cells with cytoplasmic staining.
  • Fibrinogen- Mild interstitial staining.
  • Albumin- Mild hyaline droplet change in tubular cytoplasm.
slide12
IF
  • C4d: Moderate linear peritubular capillary staining.
slide15
EM
  • is pending
diagnosis renal biopsy 5 years post tx
DiagnosisRenal Biopsy (5 years post-Tx):
  • Ab-mediated rejection with:
    • diffuse C4d positivity
    • peritubular capillaritis
    • glomerular double contours consistent with chronic transplant glomerulopathy
  • Moderate parenchymal atrophy and scarring
  • Banff scores:
    • G1 CG2 I1 CI2 T0 CT2 V0 CV0 AH1 MM1