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U07-174
#230080120
• Original disease DIC.
• Cad Tx 5 years ago.
• Creat about 90.
• Not diabetic.
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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…..
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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.
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IgG
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IgM
![Page 6: U0 7 - 174](https://reader036.fdocuments.net/reader036/viewer/2022081722/56812ca9550346895d915618/html5/thumbnails/6.jpg)
C3
![Page 7: U0 7 - 174](https://reader036.fdocuments.net/reader036/viewer/2022081722/56812ca9550346895d915618/html5/thumbnails/7.jpg)
C1q
![Page 8: U0 7 - 174](https://reader036.fdocuments.net/reader036/viewer/2022081722/56812ca9550346895d915618/html5/thumbnails/8.jpg)
kappa
![Page 9: U0 7 - 174](https://reader036.fdocuments.net/reader036/viewer/2022081722/56812ca9550346895d915618/html5/thumbnails/9.jpg)
lambda
![Page 10: U0 7 - 174](https://reader036.fdocuments.net/reader036/viewer/2022081722/56812ca9550346895d915618/html5/thumbnails/10.jpg)
fibrin
![Page 11: U0 7 - 174](https://reader036.fdocuments.net/reader036/viewer/2022081722/56812ca9550346895d915618/html5/thumbnails/11.jpg)
albumin
![Page 12: U0 7 - 174](https://reader036.fdocuments.net/reader036/viewer/2022081722/56812ca9550346895d915618/html5/thumbnails/12.jpg)
IF
• C4d: Moderate linear peritubular capillary staining.
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C4d
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C4d
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EM
• is pending
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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