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Case 6

Case 6. Helmut Hopfer , University Hospital Basel, Switzerland. morphological features. increased number of endocapillary leukocytes endothelial swelling dilatation of capillary loops occlusion or near occlusion of capillary lumina with cells u sually a focal and segmental lesion !.

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Case 6

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  1. Case 6 Helmut Hopfer, University Hospital Basel, Switzerland

  2. morphologicalfeatures • increasednumberofendocapillaryleukocytes • endothelialswelling • dilatationofcapillaryloops • occlusionornearocclusionofcapillaryluminawithcells usually a focaland segmental lesion!

  3. EM differential diagnosis • transplant glomerulitis • endocapillaryglomerulonephritis • (intravascularlymphoma)

  4. transplant glomerulitis: definition • recognizing a pattern: • increasednumberofendocapillaryleukocytes • endothelialswelling • dilatationofcapillaryloops • occlusionornearocclusionofcapillaryluminawithcells • countingmononuclearcells (arbitrarycut-off) → nocleardistinctionbetweencelltypesby light microscopy! → immunohistochemistry, definitionofcut-off by ROC Example: endocapillary immune-complex GN CD20 CD68 CD5 ERG

  5. countingcells will not tellyouanythingaboutthepathogenesis

  6. glomerularrejection: pathogenesis

  7. 2. 1. 3.

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  11. discussion & conclusions • Whyaretheleukocytesthere? • Whatarethemonocytes / macrophagesdoingthere? • Whatarethelymphocytesdoingthere? → monocytesexert an earlyendocapillaryreparativefunction on theendothelialcells

  12. casepresentation Clinical history: 39 yearold male. Renal transplantation (TR) in 2005 due tohypertension. Malcompliancewithimmunosuppresion → twoepisodesofinterstitialcellularrejection. Diagnosticbiopsy (BX) 40 months after TR, rise in creatinineandnewlydiagnosedproteinuria. Diagnosis: Transplant glomerulitis (by EM), severe diffuse interstitialcellularrejection, C4d negative. Focal IFTA (10-20%). Follow up: Dialysisdependence 7 monthslater. BX withmixed T cell- and antibody-mediatedrejection, C4d positive.

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