1. U
Failed renal transplant.
Transplant nephrectomy.
Diabetic.
Etiology of allograft unknown

2. U06-4787 DOB Feb 1971 IDDM 1980 Feb. 1998-started PD
March LURD kidney transplant
- serum creatinine at discharge 114umol/L
- immunosuppression: RAD study- Prednisone → D
- Neoral
- Cellcept or RAD
Progressive rise in creatinine to 300
-Biopsy Augest:chronic rejection,possible calcineurin toxicity
- Switch to Cellcept/ Tacrolimus with aggressive
decrease in Tacrolimus when September biopsy
only showed calcineurine toxicity. Creatinine 300→200
-creatinine 400 in November----- Biopsy showed TIN
with eosinophilie, prednisone restarted. Creat → range
progresive loss of function
PD started Feb. 2004
Transplant nephrectomy March 2006

3. Osseous metaplasia
Bone can be produced in rabbit kidney by ligating the vessels.
Bone can be produced by the direct ossification of the scar tissue.
Calcium salts act as a stimulus which induce the young connective tissue cell (fibroblast) to differentiate into bone forming cells.
Osteogenic cells are derived from the endothelial cells of the capillaries that erode the calcific plaques.

4. Review of Literature Urology 61: 462ix-462xi,2003
Bloom et al, report a case of a markedly calcified multilocular renal cell carcinoma,clear cell type, with diffuse osseous metaplasia
Urology 61: 462ix-462xi,2003
Cribbs et al report a unique case of a large calcified renal cell carcinoma with massive osseous metaplasia and bone marrow elements.
Ann Diagn Patho 3: ,1999
Chan et al report a case of osseous metaplasia occurring in a renal allograft 7 years after transplantation.
Can Assoc Radiol j 1999:50:

5. Diagnosis: Transplant Nephrectomy: Extensive hemorrhage and infarction with formation of osseous metaplasia.
Acute on chronic vascular rejection.
Severe parenchymal atrophy and scarring with tubular loss.
Reactive lymph node, negative for malignancy.
Banff scores:(G0, CG0, I2, CI3, T0, CT3, V2, CV3, AH3, MM0)