Feeling the rejection today, with ALL of the bells and whistles. Glomerulitis, peritubular capillaritis, transplant glomerulopathy, positive C4d in PTC's and GBM's, and positive DSA. One stop shopping for chronic active ABMR.
#askrenalpath F, 2 weeks after renal transplantation, Scr returned to 0.9mg/dl. She suffered flu,had a high fever and anuria, biopsy showed extensive thrombi in capillary loops and arterioles. C4d was positive, HLA increased quickly. TMA caused by ABMR, which is triggered by flu?
Did you know you don’t always need EM to diagnose peritubular capillaropathy / PTCBMML (pattern of chronic ABMR)? Sometimes you can see it on a nice silver stain. This case pictured was associated with severe TG. #renalpath#transplant@sam_albadri
A diagnosis of chronic active antibody-mediated rejection (ABMR) requires morphologic evidence of chronic tissue injury (e.g. transplant glomerulopathy), evidence of current or recent antibody interaction with the vascular endothelium (e.g. linear C4d staining of peritubular…
Checking all the boxes: Renal allograft biopsy 2 years out with persistently positive DSA's and biopsy after biopsy showing active ABMR. Now with striking transplant glomerulopathy. One stop shopping for chronic active antibody mediated rejection.
Approximately half of cases of antibody-mediated rejection are negative for donor-specific antibodies.
These have endothelial cell transcripts similar to ABMR with a +DSA and histologically look the same.
Multiple mechanisms may be at play.
@CandiceRoufosse at @GlomCon
Cortical microabscess formation is a clue to the presence of an infectious organism. Various bacteria, viruses, fungi, and even parasites may cause similar appearing lesions. This biopsy is taken from a renal transplant patient with acute kidney injury and microscopic…
Interesting case of AL-amyloidosis. Massive vascular deposits, even in hilar arterioles with glomerular sparring. Patient had minimal proteinuria given lack of glomerular amyloid. #renalpath#pathtwitter#nephrology
Do you know how the proximal tubule brush border is related to the Nobel Prize in Chemistry? Normal proximal tubules have a prominent apical brush border which is highlighted by periodic acid Schiff (PAS) staining. One clue, in fact, to the presence of tubular injury is the loss…
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