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| 2005 Update of Banff 97 Diagnostic Categories for Renal Allograft Biopsies | |
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| 1. Normal | |
| 2. Antibody mediated rejection-due to documented anti-donor antibody ('suspicious for' if antibody not demonstrated); may coincide with categories 3-6 | |
| a. Acute antibody-mediated rejection | |
Type (Grade) |
Histopathological Findings |
I |
ATN-like; C4d positive, minimal inflammation |
II |
Capillary margination and/or thromboses, C4d positive |
III |
Arterial v3 changes, C4d positive |
| b. Chronic active antibody-mediated rejection | |
Grade |
Histopathologic Findings |
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Glomerular double contours and/or peritubular capillary basement membrane multilayering and/or interstitial fibrosis/tubular atrophy and/or fibrous intimal thickening in arteries; C4d positive |
| 3. Borderline Changes:"Suspicious" for acute T-cell-mediated rejection | |
| Grade | Histopathological Findings |
"Suspicious"
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This category is used when no intimal arteritis is present, but there are foci of tubulitis (t1, t2 or t3 with i0 or i1) although the i2 t2 threshold for rejection diagnosis is not met (may coincide with categories 2, 5 and 6) |
| 4. T-cell mediated rejection (may coincide with categories 2, 5 and 6) | |
| a. Acute T-cell-mediated rejection | |
| Type (Grade) | Histopathological Findings |
| IA | Cases with significant interstitial infiltration (>25% of parenchyma affected, i2 or i3) and foci of moderate tubulitis (t2) |
| IB | Cases with significant interstitial infiltration (> 25% of parenchyma affected, i2 or i3) and foci of severe tubulitis (t3) |
| IIA | Cases with mild to moderate intimal arteritis (v1) |
| IIB | Cases with severe intimal arteritis comprising > 25% of the lumenal area (v2) |
| III | Cases with "transmural" arteritis and/or fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation (v3) |
| b. Chronic active T-cell-mediated rejection | |
Type |
Histopathological Findings |
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"Chronic allograft arteriopathy" (arterial intimal fibrosis with mononuclear cell infiltration in fibrosis, formation of neo-intima) |
| 5. Interstitial fibrosis and tubular atrophy, no evidence of any specific etiology | |
| Grade | Histopathological Findings |
| Note: Grades I, II and III may include nonspecific vascular and glomerular sclerosis, but severity is graded by tubulointerstitial features | |
Grade I (mild) |
Mild interstitial fibrosis and tubular atrophy (<25% of cortical area) |
Grade II (moderate) |
Moderate interstitial fibrosis and tubular atrophy (26-50% of cortical area) |
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Grade III (severe) |
Severe interstitial fibrosis and tubular atrophy/loss (>50% of cortical area) |
| 6. Other: Changes not considered to be due to rejection | |
Diagnosis |
Histopathological (and other) features |
| Chronic hypertension | Arterial/fibrointimal thickening with reduplication of elastica, usually with small artery and arteriolar hyaline changes |
| Calcineurin toxicity | Arteriolar hyalinosis with peripheral hyaline nodules and/or progressive increase in the absence of hypertension or diabetes. Tubular cell injury with isometric vacuolization |
| Chronic obstruction | Marked tubular dilatation. Large Tamm-Horsfall protein casts with extravasation into interstitium, and/or lymphatics |
| Bacterial pyelonephritis | Intratubular and peritubular neutrophils, lymphoid follicle formation |
| Viral infection | Viral inclusions on histology and immunohistology and/or electron microscopy |
Reference
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