1. U #
LRD kid tx March/99
Original Dis IgA

2. 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 μmol/L
Mild proteinuria and microscopic hematuria shortly after transplant
2002 increasing proteinuria to nephrotic syndrome with serum creatinine range
Avascular necrosis femoral heads :diagnosed
14/3/06 transplant biopsy: serum creatinine
protein/creatinine 25
serum albumin 42
On;prednisolone,Cellcept,Tacrolimus,Cozar,furosemide,Norvesc, acebutolol
Is all clinical + biopsy change caused by recurrent disease?

3. 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

4. IgG

5. IgM

6. Kappa

7. Albumin

11. 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)

12. U #
Renal transplant 18 months ago.
increased creatinine
prev bx 19 June
rejection

13. 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

14. IgM

15. C4d

18. 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)

19. 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)

20. U #
Original disease IgA LRD tx 1999.
↑creat 2000 with biopsy
Proteinuria 2003
Creat now>200 but proteinuria gone?

21. 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

22. IgG

23. IgM

24. C3

25. Kappa

26. Fibrin

27. Fibrin

28. Albumin

29. Albumin

33. 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)