Date post: | 30-Dec-2015 |
Category: |
Documents |
Upload: | jaquelyn-porter |
View: | 66 times |
Download: | 0 times |
U07-1845
#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.
• CMV D /R, EBV D/ R, Mismatch HLA antigens
• Medications: – Cellcept,Tacrolimus, prednisone
• Past history:– Legally blind (retinitis pigmentosa), – HTN– Dyslipidemia
• 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
• Doppler u/s: no diastolic flow, patent renal vein
• U/S: no hydronephrosis
• Renal scan: severely impaired perfusion
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.
IF
• C4d: Moderate linear peritubular capillary staining. Mild to moderate endothelial staining in small arteries.
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