U05-14259

Ms EP Chronic renal failure secondary to chronic pyelonephritis. Living-related HLA identical kidney transplant – April 1996. Recent creep in creatinine from baseline of 100-110µmol\L to 130-140µmol\L No proteinuria, hematuria Imaging normal Immunosuppression Tac, Imuran

No proteinuria, hematuria Imaging normal Immunosuppression Tac, Imuran Biopsy

Biopsy

Immunofluorescence IgG – Negative IgA – Negative IgM – Mild mesangial staining C3 – Moderate vascular staining C1q – Negative Kappa – Negative Lambda – Negative Fibrinogen – Moderate to strong interstitial staining Albumin – Moderate linear GBM staining, common finding in DM C4d- Negative

IgM

C3

Fibrin

Albumin

Diagnosis: Mild Tubular Interstitial Rejection with Patchy Mild Parenchymal Scarring Mesangial Deposits seen by electron microscopy suggesting the possibility of a subclinical Immune Complex Glomerulonephritis G0 cg0 i2 ci1 t2 ct1 v0 cv1 ah0 mm0

Biopsy 2 – 9/12/2005

Clinical History LRD kidney transplant 10 y ago Previous Bx 6 wks ago – rejection Base creatinine 90-100, creatinine now 130-150 ?residual rejection activity

Biopsy

Immunofluorescence IgG – Occasional interstitial plasma cells with cytoplasmic staining IgA – Occasional interstitial plasma cells with cytoplasmic staining IgM – Mild mesangial staining C3 – Moderate vascular staining C1q – Negative Kappa – Negative Lambda – Negative Fibrinogen – Moderate to strong interstitial staining Albumin – Negative C4d- Negative

IgG

IgA

IgM

C3

Fibrin

Diagnosis: Residual acute mild tubulointerstitial rejection (type 1A) Moderate parenchymal atrophy and fibrosis Possibly early transplant glomerulopathy EM pending g0 cg1 i2 ci2 t2 ct2 v0 cv2 ah1 mm0