CRP-31

CRP-31

Clinical History

The patient is a 36 year old black male with chronic rejection.

Gross Description

Received in saline is one wedge shaped fragment of cortex measuring 5 x 3 x 2 mm in greatest dimensions. This is bisected, and one-half is submitted for light microscopy. Note that the surgical pathology request sheet states that this is a transplant nephrectomy, but the only specimen received is this wedge shaped fragment.==Pathology==

Case CRP-031 PASH

Microscopic Description, Immunofluorescence, and Electron Microscopy

Microscopic Description

Light Microscopy

The specimen consists of a large fragment of renal cortex that contains 60 to 70 glomeruli per level. About 10% of these are obsolete. The remaining glomeruli are generally hypercellular, although the cellularity appears to be inflammatory cells distending the capillary loops rather than mesangial or endothelial cell proliferation. The PASH stain shows thickened basement membrane and focal splitting. Some of the glomeruli are severely atrophic with markedly thickened and wrinkled basement membranes. A few of the glomeruli are globally necrotic. There is diffuse marked interstitial fibrosis with marked tubular atrophy. There are also a number of large collections of mononuclear inflammatory cells throughout the biopsy and numerous examples of tubulitis are identified. The most severely involved tubules contain six to eight lymphocytes per tubular cross section. There are patchy interstitial hemorrhages throughout the biopsy. The vessels generally show obliterative endarteritis, although a few still have a small lumen. Several of the vessels also demonstrate intimal arteritis. Focal necrosis is noted in some of the vessel walls.

Diagnosis and Comments

Kidney, wedge biopsy - Severe acute interstitial and vascular rejection, Banff grade III. - Severe chronic rejection.

These findings are most consistent with severe acute and chronic rejection. This degree of acute interstitial and vascular rejection corresponds to grade III in the Banff classification.