IPLab:Lab 6:Chronic Rejection

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Clinical Summary[edit]

This 39-year-old male had malignant hypertension with malignant nephrosclerosis, progressing to chronic renal failure. He underwent a bilateral nephrectomy for control of his hypertension and received a cadaveric renal transplant. He did well, although he developed diabetes mellitus and had persistent, but less severe controllable hypertension. Two years following transplantation he was admitted to the hospital for control of his hypertension and evaluation of his chronic rejection. Initial blood pressure while in the hospital was in the range of 160/110 to 160/100 mm Hg. He was placed on a more intensive hypertension regimen, and he gradually became normotensive. He received one hemodialysis treatment prior to discharge. At the time of discharge, his blood pressure was 100 to 110 over 60 to 70 and he was doing well on dialysis. His BUN was 113 mg/dL and creatinine 5.2 mg/dL, and he had a hematocrit (PCV) of 27%. The patient was again admitted one month later for evaluation of azotemia and for control of his hypertension. It was felt that his chronic rejection was end-stage and that he would have to be dialyzed periodically. He was put on a renal failure diet, and over the period of his hospitalization, his BUN and creatinine finally stabilized at high levels. He tolerated dialysis well, and a transplant nephrectomy was done at 2 1/2 years post transplant. At the time of discharge, the patient's BUN was 78 mg/dL, creatinine 3.6 mg/dL, WBC 5000 cells/mm³, and the PCV was 26%.

Surgical Pathology Findings[edit]

The kidney weighed 215 grams and was covered by a thick capsule, which was partially adherent to the cortex, but could be stripped from the kidney with slight difficulty. The calyces and pelvis of the kidney appeared normal. The vessels were not prominent. The renal arteries and vein appeared normal.


Virtual Microscopy[edit]

Study Questions[edit]

Additional Resources[edit]


Journal Articles[edit]


Related IPLab Cases[edit]

Hypertension which has caused end-organ damage is termed malignant. Without proper treatment, these patients will usually die in less than 2 years. Blood pressures in patients with malignant hypertension are frequently 160/110 mm Hg or greater.

Renal failure is the severe reduction of renal function and often leads to reduced urinary output.

A normal BUN for this patient would be 10 to 20 mg/dL.

The normal creatinine level is 0.7 to 1.3 mg/dL.

A normal hematocrit for a male is 39 to 49%.

Azotemia is a condition of having excess nitrogen in the blood--a good indicator of reduced kidney function.

These tests are measures of kidney function. High levels mean low function.

A normal white blood cell count is 4000-11,000 cells/mm³.

A normal partial thromboplastin time is 28 to 37 seconds.

A normal kidney weighs 157 grams (range: 115 to 220 grams).

An infiltrate is an accumulation of cells in the lung parenchyma--this is a sign of pneumonia.