View source for IPLab:Lab 6:Acute Rejection

== Clinical Summary == 
This 34-year-old male with end-stage chronic glomerulonephritis had been receiving hemodialysis for 4 months when he received a  living related-donor transplantation from his mother. The transplant was successfully with no complications. However, eight days later, transplant rejection necessitated removal of the transplanted kidney.  After the nephrectomy, the patient did well and was returned to hemodialysis.

The rejected kidney was edematous and the pale tan-brown cortex was irregularly red-mottled. Upon sectioning the corticomedullary junction was not well-demarcated. The renal papillae were edematous and the renal pelvis had generalized petechial hemorrhages which extended through the 7-cm segment of ureter to a diffusely hemorrhagic terminal portion.

== Images ==
<gallery heights="250px" widths="250px">
File:IPLab6AcuteRejection1.jpg|This is a gross photograph of a kidney with acute rejection from an autopsy case. Note that the kidney is swollen (edema and inflammation) and there are areas of hemorrhage throughout the kidney. 
File:IPLab6AcuteRejection2.jpg|This is a low-power photomicrograph of the kidney that was removed from this patient. Even at this low power you can appreciate the focal accumulations of cells within this section and the diffuse cellular infiltrate (blue dots) throughout the kidney parenchyma. 
File:IPLab6AcuteRejection4.jpg|This is a higher-power photomicrograph demonstrating the cellular infiltrates within this kidney section. Note that in addition to the diffuse cellularity, the focal accumulations of cells appear to be focused around blood vessels. 
File:IPLab6AcuteRejection5.jpg|This is a higher-power photomicrograph demonstrating the cellular infiltrate within the interstitium and around the small blood vessel in the center of the image. 
File:IPLab6AcuteRejection6.jpg|This is a higher-power photomicrograph demonstrating the cellular infiltrate within the interstitium. There is some degeneration (coagulative necrosis) of tubules and glomeruli. 
File:IPLab6AcuteRejection8.jpg|This high-power photomicrograph demonstrates the cellular infiltrate within the interstitium (1) and in the wall of the blood vessel (2). 
File:IPLab6AcuteRejection9.jpg|This is a high-power photomicrograph of cells infiltrating the wall of the blood vessel. 
File:IPLab6AcuteRejection10.jpg|This high-power photomicrograph demonstrates the cellular infiltrate within the interstitium and cells within the renal tubules. 
</gallery>

== Virtual Microscopy ==
<peir-vm>IPLab6AcuteRejection</peir-vm>

== Study Questions ==
* <spoiler text="What cells make up the interstitial infiltrate seen in this case of acute transplant rejection?">Mononuclear cells - primarily CD4+ and CD8+ lymphocytes.</spoiler>
* <spoiler text="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.</spoiler>

== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/429314-overview eMedicine Medical Library: Assessment and Management of the Renal Transplant Patient]
* [http://emedicine.medscape.com/article/430128-overview eMedicine Medical Library: Renal Transplantation]
* [http://www.merckmanuals.com/professional/genitourinary_disorders/glomerular_disorders/nephrotic_syndrome.html Merck Manual: Nephrotic Syndrome]
* [http://www.merckmanuals.com/professional/genitourinary_disorders/renal_failure/chronic_kidney_disease.html Merck Manual: Chronic Kidney Disease]
* [http://www.merckmanuals.com/professional/genitourinary_disorders/renal_replacement_therapy/hemodialysis.html Merck Manual: Hemodialysis]
* [http://www.merckmanuals.com/professional/immunology_allergic_disorders/transplantation/kidney_transplantation.html Merck Manual: Kidney Transplantation]

=== Journal Articles ===
* Matas AJ.  [http://www.ncbi.nlm.nih.gov/pubmed/11272615 Impact of acute rejection on development of chronic rejection in pediatric renal transplant recipients].  ''Pediatr Transplant'' 2000 May;4(2):92-9.

=== Images ===
* [{{SERVER}}/library/index.php?/tags/2146-rejection PEIR Digital Library: Rejection Images]
* [http://library.med.utah.edu/WebPath/IMMHTML/IMMIDX.html#4 WebPath: Transplant Rejection]

== Related IPLab Cases ==
* [[IPLab:Lab 1:Kidney Infarction|Lab 1: Kidney: Infarction (Coagulative Necrosis)]]
* [[IPLab:Lab 6:Chronic Rejection|Lab 6: Kidney: Chronic Transplant Rejection]]
* [[IPLab:Lab 10:Candidiasis|Lab 10: Kidney: Candidiasis]]

{{IPLab 6}}

[[Category: IPLab:Lab 6]]