Consult Report - Case 65

Contributed by Parmjeet S. Randhawa, M.D.

PATIENT HISTORY:
Per referral report, the patient is a middle aged female. S/P renal transplant. Review of outside material.

Final Diagnosis (Case 65)

PARTS 1 AND 2:
ALLOGRAFT KIDNEY, NEEDLE BIOPSY -

CHRONIC ALLOGRAFT NEPHROPATHY, MODERATE TO SEVERE, WITH FIVE OF SEVEN GLOMERULI GLOBALLY SCLEROTIC (cg1, ci3, ct3, cv2).
BORDERLINE CHANGES, INSUFFICIENT FOR THE DIAGNOSIS OF ACUTE REJECTION (g0, i2, t1, v0)(see comment).
FOCAL ACUTE INTERSTITIAL NEPHRITIS.

Comment:
The histopathologic changes observed are primarily chronic in nature, and have progressed since the previous biopsy. A superimposed acute rejection designated as NIH-CCTT type II is mentioned in the accompanying surgical pathology report from Richland Memorial Hospital. However, the slides sent to us for review show only borderline changes. The remaining slides on this case will be procured, and a supplemental report will follow, if our interpretation changes.

Previous Biopsies on this Patient:
None

TPIS Related Resources:
Kidney Allograft Biopsy Interpretation
Kidney Transplant Topics

Gross Description - Case 65

The specimen consists of twelve (12) consult slides (2 unstained slides) and (2 HE, 8 unstained slides, one received damaged), and one (1) paraffin block with accompanying surgical pathology reports. HE, PAS and trichrome slides will be obtained in our own lab on 3 slides. Our biopsy has been previously reviewed and reported on by us.

Microscopic Description - Case 65

BANFF SCORING OF RENAL ALLOGRAFT BIOPSIES

1. Glomerulosclerosis

1.1 Number of glomeruli (7)

1.2 Number globally sclerotic (5)

1.3 Segmental sclerosis ( )YES (X)NO

2. Glomerulitis (X)0 ( )1 ( )2 ( )3

3. Interstitial inflammation ( )0 ( )1 (X )2 ( )3

4. Intimal arteritis (X)0 ( )1 ( )2 ( )3

5. Tubulitis ( )0 (X)1 ( )2 ( )3

6. Arteriolar hyalin ( )0 ( )1 ( )2 ( )3

7. Chronic glomerular change ( )0 (X)1 ( )2 ( )3

8. Interstitial fibrosis ( )0 ( )1 ( )2 (X)3

9. Tubular atrophy ( )0 ( )1 ( )2 (X)3

10. Vascular intimal sclerosis ( )0 ( )1 (X)2 ( )3

11. Other Findings EM on previous biopsy showed no immune deposits.

12. Diagnostic categories

12.1 Acute rejection (KDAR_) [g,i,t,v codes]:

( ) Grade 0 (Normal)(i0, t0, v0)
(X) Grade B (Borderline)(i0-1, t0-1, v0)
( ) Grade 1 (Mild)(i1-3, t2, v0)
( ) 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)
(X) Grade 2 (Moderate)(ci1-3, ct1-3, cv1-2)
(X) 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

1. Glomerulosclerosis
1.1 Number of glomeruli	(7)
1.2 Number globally sclerotic	(5)
1.3 Segmental sclerosis	( )YES	(X)NO
2. Glomerulitis	(X)0	( )1	( )2	( )3
3. Interstitial inflammation	( )0	( )1	(X )2	( )3
4. Intimal arteritis	(X)0	( )1	( )2	( )3
5. Tubulitis	( )0	(X)1	( )2	( )3
6. Arteriolar hyalin	( )0	( )1	( )2	( )3
7. Chronic glomerular change	( )0	(X)1	( )2	( )3
8. Interstitial fibrosis	( )0	( )1	( )2	(X)3
9. Tubular atrophy	( )0	( )1	( )2	(X)3
10. Vascular intimal sclerosis	( )0	( )1	(X)2	( )3
11. Other Findings	EM on previous biopsy showed no immune deposits.
12. Diagnostic categories
12.1 Acute rejection (KDAR_) [g,i,t,v codes]:	( ) Grade 0 (Normal)(i0, t0, v0) (X) Grade B (Borderline)(i0-1, t0-1, v0) ( ) Grade 1 (Mild)(i1-3, t2, v0) ( ) 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) (X) Grade 2 (Moderate)(ci1-3, ct1-3, cv1-2) (X) 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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