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Transplant Nephrectomy: Extensive Hemorrhage and Osseous Metaplasia

This case review discusses a failed renal transplant resulting in transplant nephrectomy, with extensive hemorrhage and the formation of osseous metaplasia. The diagnosis includes acute on chronic vascular rejection and severe parenchymal atrophy. Relevant literature on osseous metaplasia in renal cell carcinoma and renal allograft is also reviewed.

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Transplant Nephrectomy: Extensive Hemorrhage and Osseous Metaplasia

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  1. 317030700 U06-4787 Failed renal transplant. Transplant nephrectomy. Diabetic. Etiology of allograft unknown

  2. U06-4787 DOB Feb 1971 IDDM 1980 Feb. 1998-started PD March 1998- LURD kidney transplant - serum creatinine at discharge 114umol/L - immunosuppression: RAD study- Prednisone → D - Neoral - Cellcept or RAD 2000 --Progressive rise in creatinine to 300 -Biopsy Augest:chronic rejection,possible calcineurin toxicity - Switch to Cellcept/ Tacrolimus with aggressive decrease in Tacrolimus when September biopsy only showed calcineurine toxicity. Creatinine 300→200 -creatinine 400 in November----- Biopsy showed TIN with eosinophilie, prednisone restarted. Creat →250-300 range 2001-2003- progresive loss of function PD started Feb. 2004 Transplant nephrectomy March 2006

  3. Osseous metaplasia • Bone can be produced in rabbit kidney by ligating the vessels. • Bone can be produced by the direct ossification of the scar tissue. • Calcium salts act as a stimulus which induce the young connective tissue cell (fibroblast) to differentiate into bone forming cells. • Osteogenic cells are derived from the endothelial cells of the capillaries that erode the calcific plaques.

  4. Review of Literature • Bloom et al, report a case of a markedly calcified multilocular renal cell carcinoma,clear cell type, with diffuse osseous metaplasia Urology 61: 462ix-462xi,2003 • Cribbs et al report a unique case of a large calcified renal cell carcinoma with massive osseous metaplasia and bone marrow elements. Ann Diagn Patho 3:294-299,1999 • Chan et al report a case of osseous metaplasia occurring in a renal allograft 7 years after transplantation. Can Assoc Radiol j 1999:50:309-392

  5. Diagnosis:Transplant Nephrectomy:Extensive hemorrhage and infarction with formation of osseous metaplasia. Acute on chronic vascular rejection. Severe parenchymal atrophy and scarring with tubular loss. Reactive lymph node, negative for malignancy. Banff scores:(G0, CG0, I2, CI3, T0, CT3, V2, CV3, AH3, MM0)

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