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Difference between revisions of "Renal transplant pathology"
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'''Renal transplant pathology''' is grouped with the ''[[medical kidney diseases]]'', as this | '''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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===General=== | ===General=== | ||
*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> | *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+ 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> | *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=== | ===Microscopic=== | ||
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=Infection= | =Infection= | ||
==Polyomavirus== | ==Polyomavirus nephropathy== | ||
:See also: ''[[Urine_cytopathology#Human_polyomavirus_infection]]'' and ''[[Polyomavirus]]''. | |||
{{Main|Polyomavirus nephropathy}} | |||
=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). | ||
====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== | ==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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*Interstitial fibrosis and renal tubular atrophy. | *Interstitial fibrosis and renal tubular atrophy. | ||
Image | ===Images=== | ||
<gallery> | |||
Image:Chronic_allograft_nephropathy_-_intermed_mag.jpg | CAN - intermed. mag. (WC/Nephron) | |||
</gallery> | |||
==Calcineurin-inhibitor toxicity== | ==Calcineurin-inhibitor toxicity== | ||