|
Untitled
Allograft Kidney Biopsy Template
(2 H & E, 1 PAS, 1 MST, 1 Trichrome)
Click here to download printable pdf version using Adobe Acrobat Reader
| 1.1 Number of glomeruli | ( ) |
| 1.2 Number globally sclerotic | ( ) |
| 1.3 Segmental sclerosis | ( )Yes | ( ) No |
|
2. Glomerulitis (g) | ( )0 ( )1 ( )2 ( )3 |
|
3. Interstitial inflammation (i) | ( )0 ( )1 ( )2 ( )3 |
| (check if present) | ( )Neutrophils | ( ) Eosinophils |
4. Intimal arteritis (v) | ( )0 ( )1 ( )2 ( )3 ( )Not evaluable |
5. Tubulitis (t) | ( )0 ( )1 ( )2 ( )3 |
6. Arteriolar hyalin (ah) | ( )0 ( )1 ( )2 ( )3 |
7. Chronic glomerular change (cg) | ( )0 ( )1 ( )2 ( )3 |
7b. Mesangial matrix increase (mm) | ( )0 ( )1 ( )2 ( )3 |
8. Interstitial fibrosis (ci) | ( )0 ( )1 ( )2 ( )3 |
9. Tubular atrophy (ct) | ( )0 ( )1 ( )2 ( )3 |
10. Vascular intimal sclerosis (cv) | ( )0 ( )1 ( )2 ( )3 ( ) not evaluable |
10b. Number of arteries with internal elastic lamina | ( ) |
12. Diagnostic categories (check as many categories as appropriate) |
( ) KDARO: Normal |
( ) KDAB: Antibody mediated rejection |
( ) KDARB: Borderline change (i0-2, t0-2, v0) |
( ) Acute rejection (specify g,i,t,v grades): |
| ( ) KDAR1A: Banff Type 1A (i1-3, t2, v0) |
| ( ) KDAR1B: Banff Type 1B (i2-3, t3, v0) |
| ( ) KDAR2A: Banff Type 2A (i1-3, t0-3, v1) |
| ( ) KDAR2B: Banff Type 2B (i1-3, t0-3, v2) |
| ( ) KDAR3: Banff Type 3 (i1-3, t0-3, v3) |
( ) Chronic allograft nephropathy (specify cg,ci,ct,cv grades): |
| ( ) KDCR1A: Mild, without specific changes suggesting chronic rejection |
| ( ) KDCR1B: Mild, with specific changes suggesting chronic rejection |
| ( ) KDCR2A: Moderate, without specific changes suggesting chronic rejection |
| ( ) KDCR2B: Moderate, with specific changes suggesting chronic rejection |
| ( ) KDCR3A: Severe, without specific changes suggesting chronic rejection |
| ( ) KDCR3B: Severe, with specific changes suggesting chronic rejection |
( ) KDDR: Tubular and/or myocyte vacuolization c/w drug-associated changes |
( ) KDAT: Acute tubular necrosis |
( ) KDDO: Donor disease |
( ) Recurrent disease (specify) |
( ) Subcapsular injury ( ) Pyelonephritis ( ) Polyoma virus |
( ) CMV ( ) PTLD |
( ) Obstruction ( ) Reflux |
( ) Vascular thrombosis (specify) |
( ) Miscellaneous (specify) |
( ) PAS, Trichrome, MST GBM changes ( )Yes ( )No |
|
This page copyright University of Pittsburgh 2001
Last Modified: Thu Jun 18 10:14:08 EDT 2009
If you have questions, please email TPIS Administration.
|