Contributed by Parmjeet S. Randhawa, M.D.
PATIENT HISTORY: The patient is an elderly male. No clinical history is received with the specimen.


Final Diagnosis (Case 2)

ALLOGRAFT KIDNEY, NEEDLE BIOPSY -
  1. ACUTE REJECTION, MILD TO MODERATE, BANFF GRADE I/II (g0, i2, t2/3, v0).

COMMENT:
The histologic diagnosis of rejection is based on the presence of active interstitial mononuclear infiltration associated with t2/t3 tubulitis. The rejection reaction is somewhat unusual, in that it is based predominantly in the medulla.

Discussion with Dr. Ron Shapiro indicates that this is a protocol biopsy in a patient, who is clinically stable. This is presumably because the extent of parenchymal injury is insufficient to have caused a demonstrable rise in serum creatinine. Maintenance of the current immunosuppression, and close clinical monitoring is suggested. Whether active treatment of subclinical rejection episodes influences long-term graft survival has not yet been definitively established.

Previous Biopsies on this Patient:
NONE

TPIS Related Resources:
Kidney Allograft Biopsy Diagnostic Categories
Kidney Transplant Topics


Gross Description - Case 2

The specimen consists of one (1) consult slide. No report is received with the specimen.


Microscopic Description - Case 2

BANFF SCORING OF RENAL ALLOGRAFT BIOPSIES

1. Glomerulosclerosis
1.1 Number of glomeruli (14)
1.2 Number globally sclerotic (1)
1.3 Segmental sclerosis ( )YES (X)NO
2. Glomerulitis (X)0 ( )1 ( )2 ( )3
3. Interstitial inflammation ( )0 (X)1 ( )2 ( )3
4. Intimal arteritis (X)0 ( )1 ( )2 ( )3
5. Tubulitis ( )0 ( )1 (X)2 ( )3
6. Arteriolar hyalin ( )0 (X)1 ( )2 ( )3
7. Chronic glomerular change (X)0 ( )1 ( )2 ( )3
8. Interstitial fibrosis (X)0 (X)1 ( )2 ( )3
9. Tubular atrophy (X)0 (X)1 ( )2 ( )3
10. Vascular intimal sclerosis ( )0 (X)1 ( )2 ( )3
11. Other Findings Infiltrate predominantly in medulla, with small foci present in the cortex as well; venulitis involving medium-sized vessels.
12. Diagnostic categories
12.1 Acute rejection (KDAR_) [g,i,t,v codes]:
  • ( ) Grade 0 (Normal)(i0, t0, v0)
  • ( ) Grade B (Borderline)(i0-1, t0-1, v0)
  • (X) Grade 1 (Mild)(i1-3, t2, v0)
  • (X) Grade 2 (Moderate)(i1-3, t1-3, v1-2)
  • ( ) Grade 3 (Severe)(i1-3, t1-3, v3)
12.2 Chronic allograft nephropathy (KDCR_) [cg,ci,ct,cv codes]:
  • ( ) Grade 1 (Mild)(ci1-3, ct2, cv0)
  • ( ) Grade 2 (Moderate)(ci1-3, ct1-3, cv1-2)
  • ( ) Grade 3 (Severe)(ci1-3, ct1-3, cv3)
    12.3 Drug-associated changes (KDDR): ( )
    12.4 Acute tubular necrosis (KDAT): ( )
    12.5 Donor diseases (KDDO): ( )
    12.3 Other:
    • ( ) Recurrent disease
    • ( ) Subcapsular injury
    • ( ) CMV
    • ( ) Obstruction
    • ( ) Vascular thrombosis
    • ( ) Pyelonephritis
    • ( ) PTLD
    • ( ) Reflux
    • ( ) Miscellaneous


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