Renal transplant pathology: Difference between revisions

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'''Renal transplant pathology''' is grouped with the ''[[medical kidney diseases]]'', as this one leads to the other, and many renal transplants have recurrence of the pathology that lead to renal failure.
'''Renal transplant pathology''', also '''kidney tranplant pathology''', is grouped with the ''[[medical kidney diseases]]'', as this usually precedes the transplant.  Also, many renal transplants have recurrence of the pathology that lead to renal failure.


=Rejection=
=Rejection=
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| severe interstitial fibrosis and tubular atrophy
| severe interstitial fibrosis and tubular atrophy
|}
|}
==Predictors==
==C4d staining==
*Associated with C4d+ IHC.<ref name=pmid1747954>Vascular deposition of complement-split products in kidney allografts with cell-mediated rejection. Feucht HE, Felber E, Gokel MJ, Hillebrand G, Nattermann U, Brockmeyer C, Held E, Riethmüller G, Land W, Albert E. Clin Exp Immunol. 1991 Dec;86(3):464-70. PMID 1747954.</ref>
===General===
*Mean graft survival is ~4 years for C4d+ interstitial capillaries vs. ~8 years for C4d- renal grafts.<ref name=pmid11135088>Impact of humoral alloreactivity early after transplantation on the long-term survival of renal allografts. Lederer SR, Kluth-Pepper B, Schneeberger H, Albert E, Land W, Feucht HE. Kidney Int. 2001 Jan;59(1):334-41. PMID 11135088.</ref>
*Acute rejection associated with C4d staining.<ref name=pmid1747954>Vascular deposition of complement-split products in kidney allografts with cell-mediated rejection. Feucht HE, Felber E, Gokel MJ, Hillebrand G, Nattermann U, Brockmeyer C, Held E, Riethmüller G, Land W, Albert E. Clin Exp Immunol. 1991 Dec;86(3):464-70. PMID 1747954.</ref>
*Mean graft survival is ~4 years for C4d +ve interstitial capillaries vs. ~8 years for C4d -ve renal grafts.<ref name=pmid11135088>Impact of humoral alloreactivity early after transplantation on the long-term survival of renal allografts. Lederer SR, Kluth-Pepper B, Schneeberger H, Albert E, Land W, Feucht HE. Kidney Int. 2001 Jan;59(1):334-41. PMID 11135088.</ref>
 
===Microscopic===
Features:<ref>URL: [http://www.humpath.com/spip.php?article14451 http://www.humpath.com/spip.php?article14451]. Accessed on: 22 November 2011.</ref>
*Diffuse cytoplasmic C4d staining of the peritubular capillaries.
 
Image:
*[http://www.humpath.com/spip.php?article14451 Positive C4d staining (humpath.com)].


==Acute rejection==
==Acute rejection==
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=Infection=
=Infection=
==Polyomavirus==
==Polyomavirus nephropathy==
===General===
:See also: ''[[Urine_cytopathology#Human_polyomavirus_infection]]'' and ''[[Polyomavirus]]''.
*This bad-boy is associated with failure of transplanted kidneys.<ref name=pmid216990>{{cite journal |author=Mackenzie EF, Poulding JM, Harrison PR, Amer B |title=Human polyoma virus (HPV)--a significant pathogen in renal transplantation |journal=Proc Eur Dial Transplant Assoc |volume=15 |issue= |pages=352–60 |year=1978 |pmid=216990 |doi= |url=}}</ref>
{{Main|Polyomavirus nephropathy}}
*Treatment: reduce immunosuppression.<ref name=Nickeleit>Nickeleit, Volker; Singh, Harsharan K. Polyomavirus Allograft Nephropathy: Clinico-Pathological Correlations. URL: [http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=eurekah&part=A74503#A74539 http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=eurekah&part=A74503#A74539]. Accessed on: 8 November 2010.</ref>
 
===Microscopic===
Features:<ref name=Nickeleit/>
*Ground glass-like nuclear inclusions.
*Nuclear enlargement.
 
Image:
*[http://tpis1.upmc.com:81/tpis/GU/G00011a.html Polyomavirus (upmc.com)].<ref>URL: [http://tpis1.upmc.com:81/tpis/kidney/KAINbk.html http://tpis1.upmc.com:81/tpis/kidney/KAINbk.html]. Accessed on: 11 November 2011.</ref>
 
===IHC===
Features:
*SV40 +ve (nuclear staining).
 
Image:
*[http://tpis1.upmc.com:81/tpis/GU/G00011b.html Polyomavirus (upmc.com)].


=Transplant-related pathology=
=Transplant-related pathology=
==Transplant glomerulopathy==
==Transplant glomerulopathy==
*Abbreviated ''TG''.
===General===
*Pathology that arises in the glomeruli of transplanted kidneys.
*Considered to be a form of ''chronic antibody-mediated rejection''.<ref name=pmid21960169>{{Cite journal  | last1 = Haas | first1 = M. | title = Transplant glomerulopathy: it's not always about chronic rejection. | journal = Kidney Int | volume = 80 | issue = 8 | pages = 801-3 | month = Oct | year = 2011 | doi = 10.1038/ki.2011.192 | PMID = 21960169 }}</ref>


===Microscopic===
===Microscopic===
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*Segmental and global glomerular sclerosis.
*Segmental and global glomerular sclerosis.


DDx (tram-tracking):
DDx (tram-tracking):<ref name=pmid21960169/>
*[[MPGN]].
*[[MPGN]] (hepatitis C).
*[[Thrombotic microangiopathy]] (TMA).
*[[Thrombotic microangiopathy]] (TMA).


==Chronic allograph nephropathy==
====Images====
<gallery>
Image:Transplant_glomerulopathy_-_intermed_mag.jpg | Transplant glomerulopathy - intermed. mag. (WC/Nephron)
Image:Transplant_glomerulopathy_-_high_mag.jpg | Transplant glomerulopathy - high mag. (WC/Nephron)
Image:Transplant_glomerulopathy_-_very_high_mag.jpg | Transplant glomerulopathy - very high mag. (WC/Nephron)
</gallery>
 
==Chronic allograft nephropathy==
*Abbreviated ''CAN''.
*[[AKA]] ''chronic/sclerosing allograft nephropathy''.
===General===
===General===
*Month-years post-transplant.
*Month-years post-transplant.
*Gradual decline in graft function.
*Gradual decline in graft function - typically with hypertension and hematuria.<ref name=pmid15954891>{{Cite journal  | last1 = Joosten | first1 = SA. | last2 = Sijpkens | first2 = YW. | last3 = van Kooten | first3 = C. | last4 = Paul | first4 = LC. | title = Chronic renal allograft rejection: pathophysiologic considerations. | journal = Kidney Int | volume = 68 | issue = 1 | pages = 1-13 | month = Jul | year = 2005 | doi = 10.1111/j.1523-1755.2005.00376.x | PMID = 15954891 }}
</ref>
*Leading cause of chronic graft failure.<ref name=pmid10469349>{{Cite journal  | last1 = Paul | first1 = LC. | title = Chronic allograft nephropathy: An update. | journal = Kidney Int | volume = 56 | issue = 3 | pages = 783-93 | month = Sep | year = 1999 | doi = 10.1046/j.1523-1755.1999.00611.x | PMID = 10469349 }}</ref>


===Microscopic===
===Microscopic===
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**Due to intimal and medial thickening.
**Due to intimal and medial thickening.
*Interstitial fibrosis and renal tubular atrophy.
*Interstitial fibrosis and renal tubular atrophy.
===Images===
<gallery>
Image:Chronic_allograft_nephropathy_-_intermed_mag.jpg | CAN - intermed. mag. (WC/Nephron)
</gallery>


==Calcineurin-inhibitor toxicity==
==Calcineurin-inhibitor toxicity==
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Features:
Features:
*Hyaline arteriopathy with a peripheral and nodular distribution (chronic toxicity).
*Hyaline arteriopathy with a peripheral and nodular distribution (chronic toxicity).
*+/-Thrombotic microangiopathy - see ''[[Thrombotic_microangiopathy#Microscopic|microscopic for TMA]]''.


=See also=
=See also=
Retrieved from "https://librepathology.org/wiki/Renal_transplant_pathology"