1. 66 F PMH: HTN, Gout, DVT (Feb/06 and ? Sep/06) PMH: Heterozygous for Prothrombin mutation. FOCAL PROLIFERATIVE IMMUNE COMPLEX GN (toward chronic GN)  Biopsy done in 2004, pANCA positive. On PD then switch to HD on May 2006 Medications on admission: Fragmin, Replavite, Crestor Living Related Kidney Transplant (14-Nov- 06)

2. U04-22639 #897870100 Native kidney 64 y.o. female with Cr 188, 3+ hemoglobinuria, about 300  g proteinuria Vasculitic work-up negative

3. IF IgG- Minimal wipsy mesangial staining, looks just discernibly above background. IgA- Negative. IgM- Minimal to mild fine granular mesangial staining. C3- Mild vascular and vascular pole staining. C1q- Negative. Kappa- Trace level fine granular mesangial staining. Lambda- Negative. Fibrinogen- Mild to moderate interstitial staining. Albumin- Moderate background with mild hyaline droplet change in tubular cytoplasm.

4. IgG

5. IgM

6. C3

7. Kappa

8. Fibrin

9. Albumin

13. Diagnosis Renal Biopsy: Focal proliferative immune complex glomerulonephritis progressing toward chronic glomerulonephritis.

14. Ms. CH 66 F PMH: HTN, Gout, DVT (Feb/06 and ? Sep/06) PMH: Heterozygous for Prothrombin mutation. FOCAL PROLIFERATIVE IMMUNE COMPLEX GN (toward chronic GN)  Biopsy done in 2004, pANCA positive. On PD then switch to HD on May 2006 Medications on admission: Fragmin, Replavite, Crestor Living Related Kidney Transplant (14-Nov- 06)

15. U06-21732 #897870100 LRD Tx

16. Diagnosis Renal Biopsy (at time of implantation): No specific diagnostic findings Minimal arteriosclerotic vascular changes

17. Hospital Course: Excellent/ immediate post-op kidney function. Hypotension and low Hgb: 3 units PRBC Immunosuppression: 1.Belatacept (Belatacept benefit study) 2.Prednisone 3.MMF Meds on discharge: Crestor, Valganciclovir, Replavite, Losec, MMF, Prednisone, Benefit008 study drug, phosphate, senokot, Fragmin. Started on coumadin Nov 28 th.

18. Creatinine started to rise Nov 28 th. Developed macroscopic hematuria Dec 2 nd.

19. Follow up Visits: Other work up: -LD, T. Bili, ALT: NL -P-ANCA + -PBS: NL -Hapto: Pending -Peak creatinine 204 µmol/L Dec 8 th -Hem/Onc Consult on Dec 13 th Date:Creat: Nov 14215 Nov 17100 Nov 3097 Dec 1120 Dec 6162 (1 st Bx) Dec 11192 (2 nd Bx) Dec 14189

20. Kidney Biopsies ?

21. U06-23272 #897870100 LRD Tx 14/11/06 Creat 70  140 over several days

22. IF C4d- Negative.

23. EM Will follow in the coming weeks

24. Diagnosis Renal Biopsy (1 week post-Tx): Tubular hemorrhage and injury Further report to follow Banff score: G0 I1 T1 V0 AH0 Biopsy of marginal adequacy

25. U06-23805 #897870100 LRD kid Tx 1 month ago Creat 70  200 Previous biopsy 1 week ago Why blood in tubules ? With proteinuria

26. IF C4d- Negative.

27. EM Will follow in the coming weeks

28. Diagnosis Renal Biopsy (1 month post-transplantation) Thrombotic microangiopathy of uncertain etiology –Banff score: G0 I1 T1 V0 AH0 –Further report to follow Tubular hemorrhage, injury, and regenerative features