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U0 7 - 1845

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.

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U0 7 - 1845

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

  2. 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

  3. 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

  4. Doppler u/s: no diastolic flow, patent renal vein • U/S: no hydronephrosis • Renal scan: severely impaired perfusion

  5. 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.

  6. IgM

  7. C3

  8. C3

  9. lambda

  10. fibrinogen

  11. fibrinogen

  12. fibrinogen

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

  14. C4d

  15. C4d

  16. C4d

  17. EM • Is pending

  18. 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

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