IPLab:Lab 6:Acute Rejection
This 34-year-old white male with end-stage chronic glomerulonephritis had been receiving hemodialysis three times per week for 4 months when he was admitted to the hospital for a living related-donor transplantation from his mother. Other than the kidney disease, the patient was in good health. The transplant was performed successfully with no complications. However, eight days later, transplant rejection necessitated returning the patient to the operating room for a nephrectomy of the transplanted kidney. After the nephrectomy, the patient did quite well, was returned to hemodialysis, and was discharged home in good condition.
The kidney weighed 240 gramsA normal kidney weighs 157 grams (range: 115 to 220 grams). and was edematous. The capsule stripped with ease to reveal a pale tan-brown cortex which was irregularly red-mottled. Upon sectioning, the cortical band was ill-defined, and the corticomedullary junction was not well-demarcated. The renal papillae were edematous and the renal pelvis displayed generalized petechial hemorrhages which extended through the 7-cm segment of ureter to a diffusely hemorrhagic terminal portion.
Mononuclear cells - primarily CD4+ and CD8+ lymphocytes.
- What is the cellular response seen in the acute rejection vasculitis in this case of acute transplant rejection?
Neutrophils are recruited to the lesions due to immunoglobulin deposition and complement fixation. There is also deposition of fibrin and thrombosis.
- eMedicine Medical Library: Assessment and Management of the Renal Transplant Patient
- eMedicine Medical Library: Renal Transplantation
- Merck Manual: Nephrotic Syndrome
- Merck Manual: Chronic Kidney Disease
- Merck Manual: Hemodialysis
- Merck Manual: Kidney Transplantation
- Matas AJ. Impact of acute rejection on development of chronic rejection in pediatric renal transplant recipients. Pediatr Transplant 2000 May;4(2):92-9.
Related IPLab Cases
- Lab 1: Kidney: Infarction (Coagulative Necrosis)
- Lab 6: Kidney: Chronic Transplant Rejection
- Lab 10: Kidney: Candidiasis