U06-306#12581591/121

Cad Tx 14/05/2004Creatinine 100 200 early December 2005.US normal.Original disease IgA nephropathy.

Original kidney disease: Buerger’s IgACadaveric kidney transplant May 2004 - post discharge baseline creatinine 110-120 µmol/LSerum creatinine 14/07/05: 104Serum creatinine 29/11/05: 168. Patient claims flu-like illness with dehydrationRepeat creatinine 167. Follow-up creatinine missed. Biopsy planned post holidaysMVA 04/01/06 Creatinine 262 blood and protein in urineBiopsy 06/01/06 Creatinine 209

13/01/06 Creatinine 178

IF• IgG- Negative• IgA- Negative• IgM- Negative• C3- Moderate vascular and mild punctate

mesangial staining • C1q- Negative• Kappa- Negative• Lambda- Negative • Fibrin- Moderate interstitial staining• Albumin- Negative• C4d- Negative

C3

C3

Fibrin

Diagnosis:Renal Biopsy (20 months post-transplantation):Acute tubulointerstitial rejection (Type IB) with signs of acute tubular injury and regeneration.Probable early chronic transplant glomerulopathy, suggested by Electron Microscopy.(G0 CG0 I2 CI2 T3 CT2 V0 CV2 AH0 MM1)