U04-22639

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Transcript U04-22639

66 F
• PMH: HTN, Gout, DVT (Feb/06 and ?
Sep/06)
• PMH: Heterozygous for Prothrombin
mutation.
• FOCAL PROLIFERATIVE IMMUNE
COMPLEX GN (toward chronic GN) 
Biopsy done in 2004, pANCA positive.
• On PD then switch to HD on May 2006
• Medications on admission: Fragmin,
Replavite, Crestor
• Living Related Kidney Transplant (14-Nov06)
U04-22639
#897870100
• Native kidney
• 64 y.o. female with Cr 188, 3+
hemoglobinuria, about 300 g proteinuria
• Vasculitic work-up negative
IF
• IgG- Minimal wipsy mesangial staining, looks just
discernibly above background.
• IgA- Negative.
• IgM- Minimal to mild fine granular mesangial
staining.
• C3- Mild vascular and vascular pole staining.
• C1q- Negative.
• Kappa- Trace level fine granular mesangial staining.
• Lambda- Negative.
• Fibrinogen- Mild to moderate interstitial staining.
• Albumin- Moderate background with mild hyaline
droplet change in tubular cytoplasm.
IgG
IgM
C3
Kappa
Fibrin
Albumin
Diagnosis
Renal Biopsy:
• Focal proliferative immune complex
glomerulonephritis progressing toward
chronic glomerulonephritis.
Ms. CH 66 F
• PMH: HTN, Gout, DVT (Feb/06 and ?
Sep/06)
• PMH: Heterozygous for Prothrombin
mutation.
• FOCAL PROLIFERATIVE IMMUNE
COMPLEX GN (toward chronic GN) 
Biopsy done in 2004, pANCA positive.
• On PD then switch to HD on May 2006
• Medications on admission: Fragmin,
Replavite, Crestor
• Living Related Kidney Transplant (14-Nov06)
U06-21732
#897870100
• LRD Tx
Diagnosis
Renal Biopsy (at time of implantation):
• No specific diagnostic findings
• Minimal arteriosclerotic vascular changes
Hospital Course:
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Excellent/ immediate post-op kidney function.
Hypotension and low Hgb: 3 units PRBC
Immunosuppression:
Belatacept (Belatacept benefit study)
Prednisone
MMF
Meds on discharge: Crestor, Valganciclovir,
Replavite, Losec, MMF, Prednisone, Benefit008
study drug, phosphate, senokot, Fragmin.
Started on coumadin Nov 28th.
• Creatinine started to rise Nov 28th.
• Developed macroscopic hematuria Dec 2nd.
Follow up Visits:
Other work up:
- LD, T. Bili, ALT: NL
- P-ANCA +
- PBS: NL
- Hapto: Pending
- Peak creatinine 204
µmol/L Dec 8th
- Hem/Onc Consult
on Dec 13th
Date:
Creat:
Nov 14
215
Nov 17
100
Nov 30
97
Dec 1
120
Dec 6
162 (1st Bx)
Dec 11
192 (2nd Bx)
Dec 14
189
Kidney Biopsies
?
U06-23272
#897870100
• LRD Tx 14/11/06
• Creat 70  140 over several days
IF
• C4d- Negative.
EM
• Will follow in the coming weeks
Diagnosis
Renal Biopsy (1 week post-Tx):
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Tubular hemorrhage and injury
Further report to follow
Banff score: G0 I1 T1 V0 AH0
Biopsy of marginal adequacy
U06-23805
#897870100
• LRD kid Tx 1 month ago
• Creat 70  200
• Previous biopsy 1 week ago
• Why blood in tubules ? With proteinuria
IF
• C4d- Negative.
EM
• Will follow in the coming weeks
Diagnosis
Renal Biopsy (1 month post-transplantation)
• Thrombotic microangiopathy of uncertain
etiology
– Banff score: G0 I1 T1 V0 AH0
– Further report to follow
• Tubular hemorrhage, injury, and
regenerative features