1. U

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

3. No proteinuria, hematuria
Imaging normal
Immunosuppression Tac, Imuran
Biopsy

4. Biopsy

5. 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

6. IgM

7. C3

8. Fibrin

9. Albumin

13. 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

14. Biopsy 2 – 9/12/2005

15. Clinical History LRD kidney transplant 10 y ago
Previous Bx 6 wks ago – rejection
Base creatinine , creatinine now
?residual rejection activity

16. Biopsy

17. 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

18. IgG

19. IgA

20. IgM

21. C3

22. Fibrin

23. 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