Renal Allograft Biopsy Differential Diagnosis
Kidney Transplantation

Differential Diagnosis: Entities in "Other" Category for Diagnosis of Renal Allograft Biopsies*
1. Posttransplant Lymphoproliferative Disorder
  • Nodular or diffuse interstitial infiltration by mononuclear cells with serpiginous necrosis. Confirmation requires demonstration of EBV infection in a majority of the infiltrating lymphocytes
2. Nonspecific Changes
Focal interstitial inflammation without tubulitis
Reactive vascular changes
3. Acute Tubular Necrosis
  • Cell loss, non-replacement
  • Cell necrosis
  • Regenerative changes
  • Interstitial edema, mild infiltrate
  • Nucleated cells in vasa recta
4. Acute Interstitial Nephritis
5. FK506/Cyclosporin Associated Changes, Acute or Chronic
  • Isometric vacuolization
  • Eosinophilic inclusions
  • Microcalcifications
  • Nodular hyaline afferent arteriolar deposits
  • Thrombotic microangiopathy
  • Occlusive arteriolar change
  • Medial degeneration
  • Striped or patchy fibrosis
  • Sclerosis or ischemic collapse
  • Juxtaglomerular apparatus hyperplasia
6. Subcapsular injury "healing in"
7. Pretransplant Acute Endothelial Injury
8. Papillary Necrosis
9. De novo Glomerulonephritis
10. Recurrent Disease
  • Immune complex glomerulonephritis
  • Focal segmental sclerosis
  • Diabetes
  • Hemolytic-uremic syndrome
  • Other
11. Pre-Existing Disease
12. Viral infection
13. Obstruction/reflux/urine leak
14. Other
* Changes not considered to be due to rejection
  1. Solez K, et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: The Banff working classification of kidney transplant pathology. Kidney Int 1993;44(2):411-22.
  2. Solez K, et al. Report of the third Banff conference on allograft pathology (July 20-24, 1995) on classification and lesion scoring in renal allograft pathology. Trans Proc 1996;28(1):441-4.
  3. Racusen L, et al. The Banff 97 working classification of renal allograft pathology. Kidney Int1999;55:713-723
  4. Randhawa PS, et al. Microvascular changes in renal allografts associated with FK506 (Tacrolimus) therapy. Am J Surg Pathol 1996;20(3):306-12.
  5. Randhawa PS, et al. Renal allograft involvement by Epstein-Barr Virus associated posttransplant lymphoproliferative disease. Am J Surg Pathol 1996;20(5):563-71.
  6. Olsen S, et al. Primary acute renal failure ("acute tubular necrosis") in the transplanted kidney: morphology and pathogenesis.Medicine 1989;68:173-187
  7. Hariharan S, et al. Recurrent and denovo renal diseaes after renal transplantion: a report from the renal allograft disease registry.Am J Kid Dis 1998;31:928-931
  8. Randhawa PS, et al. Human polyoma virus associated interstitial nephritis in the allograft kidney.Transplantation 1999;67:103-109
  9. Kashyap R, et al. The clinical significance of cytomegaloviral inclusions in the kidney.Am J Kid Dis 1998;31:928-931

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Last Modified: Thu Jun 18 10:14:08 EDT 2009


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