Difference between revisions of "Renal transplant pathology"
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===Microscopic=== | ===Microscopic=== | ||
Features: | Features:<ref name=Ref_DARP411>{{Ref DARP|411}}</ref> | ||
*Irregular GBM thickening - '''key feature'''. | |||
*Tram-tracking of basement membrane. | *Tram-tracking of basement membrane. | ||
*Increased mesangial matrix. | |||
*Segmental and global glomerular sclerosis. | |||
DDx (tram-tracking): | DDx (tram-tracking): | ||
*[[MPGN]]. | *[[MPGN]]. | ||
*[[Thrombotic microangiopathy]] (TMA). | *[[Thrombotic microangiopathy]] (TMA). | ||
==Chronic allograph nephropathy== | |||
===General=== | |||
*Month-years post-transplant. | |||
*Gradual decline in graft function. | |||
===Microscopic=== | |||
Features:<ref name=Ref_DARP411>{{Ref DARP|411}}</ref> | |||
*Arterial & arteriolar luminal narrowing - '''key feature'''. | |||
**Due to intimal and medial thickening. | |||
*Interstitial fibrosis and renal tubular atrophy. | |||
==Calcineurin-inhibitor toxicity== | ==Calcineurin-inhibitor toxicity== | ||
Revision as of 15:19, 7 November 2011
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.
Rejection - overview
Rejection can be:
- Acute.
- Chronic.
- Acute-on-chronic.
Predictors
- Associated with C4d+ IHC.[1]
- Mean graft survival is ~4 years for C4d+ interstitial capillaries vs. ~8 years for C4d- renal grafts.[2]
Acute rejection
- Acute rejection has a standardized classification Banff classification.[3]
Diagnosis of acute rejection requires:
- Serology.
- IHC (C4d).
- This is somewhat debated.
- Morphology.
Infection
Polyomavirus
General
- This bad-boy is associated with failure of transplanted kidneys.[4]
- Treatment: reduce immunosuppression.[5]
Microscopic
Features:[5]
- Ground glass-like nuclear inclusions.
- Nuclear enlargement.
Transplant glomerulopathy
Microscopic
Features:[6]
- Irregular GBM thickening - key feature.
- Tram-tracking of basement membrane.
- Increased mesangial matrix.
- Segmental and global glomerular sclerosis.
DDx (tram-tracking):
- MPGN.
- Thrombotic microangiopathy (TMA).
Chronic allograph nephropathy
General
- Month-years post-transplant.
- Gradual decline in graft function.
Microscopic
Features:[6]
- Arterial & arteriolar luminal narrowing - key feature.
- Due to intimal and medial thickening.
- Interstitial fibrosis and renal tubular atrophy.
Calcineurin-inhibitor toxicity
General
- Calcineurin-inhibitors (e.g. cyclosporine,[7] tacrolimus[8]) toxicity can induce a thrombotic microangiopathy.
Microscopic
Features:
- Hyaline arteriopathy with a peripheral and nodular distribution (chronic toxicity).
See also
References
- ↑ 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.
- ↑ 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.
- ↑ Racusen LC, Solez K, Colvin RB, et al. (February 1999). "The Banff 97 working classification of renal allograft pathology". Kidney Int. 55 (2): 713–23. doi:10.1046/j.1523-1755.1999.00299.x. PMID 9987096. http://www.nature.com/ki/journal/v55/n2/full/4490631a.html.
- ↑ Mackenzie EF, Poulding JM, Harrison PR, Amer B (1978). "Human polyoma virus (HPV)--a significant pathogen in renal transplantation". Proc Eur Dial Transplant Assoc 15: 352–60. PMID 216990.
- ↑ 5.0 5.1 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. Accessed on: 8 November 2010.
- ↑ 6.0 6.1 Fogo, Agnes B.; Kashgarian, Michael (2005). Diagnostic Atlas of Renal Pathology: A Companion to Brenner and Rector's The Kidney 7E (1st ed.). Saunders. pp. 411. ISBN 978-1416028710.
- ↑ Zarifian A, Meleg-Smith S, O'donovan R, Tesi RJ, Batuman V (June 1999). "Cyclosporine-associated thrombotic microangiopathy in renal allografts". Kidney Int. 55 (6): 2457–66. doi:10.1046/j.1523-1755.1999.00492.x. PMID 10354295.
- ↑ Fogo, Agnes; Bruijn, Jan A.; Cohen, Arthur H.; Colvin, Robert B.;Jennette, J. Charles (2006). Fundamentals of Renal Pathology (1st ed.). Springer. pp. 203. ISBN 978-0387311265.