U99-13179 #273396820 LRD kid tx March/99 Original Dis IgA.

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Presentation transcript:

U99-13179 #273396820 LRD kid tx March/99 Original Dis IgA

U99-13179 DOB 26/5/67 1988 kidney biopsy with diagnosis Bergers IgA nephropathy 1997 September creatinine 500 1998 June creatinine 1300-urgent hemodialysis 1999 March start kidney transplant from sister Therapy: prednisone,Neoral,MMF/rad B25/ study Stable post transplant, creatinine 80-100 μmol/L Mild proteinuria and microscopic hematuria shortly after transplant 2002 increasing proteinuria to nephrotic syndrome with serum creatinine 120-180 range Avascular necrosis femoral heads :diagnosed 14/3/06 transplant biopsy: serum creatinine 250-300 protein/creatinine 25 serum albumin 42 On;prednisolone,Cellcept,Tacrolimus,Cozar,furosemide,Norvesc, acebutolol Is all clinical + biopsy change caused by recurrent disease?

IF IgG- mild linear glomerular capillary(artifact?) IgA- negative IgM- trace mesangial-essentially negative C3- moderate vascular and interstitial capillary C1q-negative. Kappa-mild linear glomerular,similar to IgG.Also moderate tubular droplet Lambda-mild tubular droplet only Fibrin- minimal interstitial Albumin- strong tubular droplet and flat background

IgG

IgM

Kappa

Albumin

Diagnosis: Renal Biopsy: Borderline changes. No definitive evidence of rejection Rule out bacterial infection Banff score: (G1 CG0 I1 CT1 T1 CT1 V0 CV1 AH0 MM0)

U00-8893 #273396820 Renal transplant 18 months ago. increased creatinine prev bx 19 June rejection

IF IgG: negative IgA: negative IgM: mild mesangial staining C3: negative C1q: negative Kappa:negative Lambda:negative Fibrinogen: negative Albumin:negative C4d: Mild arteriolar staining.none in peritubular capillary

IgM

C4d

Diagnosis: Renal Biopsy: Probable chronic rejection with superimposed FK506 toxicity and acute tubular necrosis Banff score: (G0.CG1.I1,CT2,T1,CT2,V0,CV2,AH1,MM1)

Diagnosis: Renal Biopsy: Probable chronic rejection with superimposed FK506 toxicity and acute tubular necrosis. Banff score: (G0.CG1.I1,CT2,T1,CT2,V0,CV2,AH1,MM1)

U06-4991 #273396820 Original disease IgA LRD tx 1999. ↑creat 2000 with biopsy Proteinuria 2003 Creat now>200 but proteinuria gone?

IF IgG- moderate to strong linear GBM staining IgA- negative IgM- trivial mesangial staining C3- mild vascular staining C1q-negative. Kappa-moderate linear GBM staining Lambda-negative Fibrin- mild interstitial staining/mild glomerular staining Albumin- minimal hyaline droplet change in tubular cytoplasm and mild linear GBM staining C4d:No tissue left for C4d staining

IgG

IgM

C3

Kappa

Fibrin

Fibrin

Albumin

Albumin

Diagnosis: Renal Biopsy:(seven years post-transplantation) Chronic transplant glomerulopathy with 50% Glomerulosclrerosis Moderate parenchymal atrophy and scarring. Moderate hyaline arteriolar thickening suggesting calcinurine inhibitor toxicity. No evidence of acute rejection. Banff score: (G1 CG2 I1 CI2 T0 CT2 V0 CV1AH2 MM2)