u0 7 - 174
DESCRIPTION
U0 7 - 174. #230080120 Original disease DIC. Cad Tx 5 years ago. Creat about 90. Not diabetic. U07-00174 24 year old Asian female meningococcemia at age 17 with purpura fulminans, digital infarcts/amputations, and irreversible ARF - PowerPoint PPT PresentationTRANSCRIPT
U07-174
#230080120
• Original disease DIC.
• Cad Tx 5 years ago.
• Creat about 90.
• Not diabetic.
U07-00174
• 24 year old Asian female
• meningococcemia at age 17 with purpura fulminans, digital infarcts/amputations, and irreversible ARF
• deceased donor renal Tx 16 November 2001; 2 yr old pediatric donor
• 7% flow PRA against class II HLA, negative against class I HLA
• good initial function
• maintenance immunosuppression with prednisone, MMF and cyclosporine (2h levels 500-800 µg/L); reduced MMF 500 mg BID due to leukopenia
• baseline creatinine 80-95 µM
• creep in creatinine to 95-105 µM through 2006; 114 µM in January 2007
• normal urinalysis with protein/creatinine ratio 11 mg/mmol in Oct 2005; trace protein in January 2007 (protein/creatinine ratio pending)
• retrospective flow B cell XM positive against donor at time of Tx; currently stronger. T cell XM also positive ?real. Flow PRA 20-35% against class II.
• Bx performed which reveals…..
IF• IgG- Mild cytoplasmic staining of interstitial plasma cells. • IgA- Negative.• IgM- Trivial to mild mesangial staining. • C3- Moderate vascular staining. • C1q- Mild to moderate patchy granular staining along the
periphery of capillary loops. • Kappa and Lambda- Moderate numbers of interstitial
plasma cells with cytoplasmic staining. • Fibrinogen- Mild interstitial staining. • Albumin- Mild hyaline droplet change in tubular
cytoplasm.
IgG
IgM
C3
C1q
kappa
lambda
fibrin
albumin
IF
• C4d: Moderate linear peritubular capillary staining.
C4d
C4d
EM
• is pending
DiagnosisRenal Biopsy (5 years post-Tx):• Ab-mediated rejection with:
– diffuse C4d positivity– peritubular capillaritis– glomerular double contours consistent with
chronic transplant glomerulopathy
• Moderate parenchymal atrophy and scarring• Banff scores:
– G1 CG2 I1 CI2 T0 CT2 V0 CV0 AH1 MM1