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U07-1845 #844043110 • 54 y.o. male • Deceased donor renal transplant April 18/06 (APCKD) • Creat 120 170 515 • Being treated for CMV • Rejection?

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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. - PowerPoint PPT Presentation

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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.

IgM

C3

C3

lambda

fibrinogen

fibrinogen

fibrinogen

IF

• C4d: Moderate linear peritubular capillary staining. Mild to moderate endothelial staining in small arteries.

C4d

C4d

C4d

EM

• Is pending

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