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: • • • 1. 2. 3. • • 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): • • • • 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