Consult Report

Contributed by Parmjeet S. Randhawa, MD

PATIENT HISTORY: The patient is a middle aged male status post renal transplant, primary disease unknown. Patient with elevated creatinine. The patient has malaise and fever with a past history of CMV. No previous biopsy is available for review. Receiving FK506 and Prednisone.

Final Diagnosis (Case 1)

ALLOGRAFT KIDNEY, NEEDLE BIOPSY -

TUBULAR AND MYOCYTE VACUOLIZATION, CONSISTENT WITH DRUG EFFECT.
SINGLE GLOMERULAR CAPILLARY ENDOTHELIAL CELL, SUSPICIOUS FOR CMV INFECTION; SUGGEST CORRELATION WITH CMV ANTIGENEMIA TEST; immunoperoxidase stain to follow).

Addendum:
Immunocytochemical stain for cytomegalovirus is equivocal. Correlation with urine culture and CMV antigenemia is suggested. The MST stain shows fibrin deposition within afferent arterioles.

Previous Biopsies on this Patient:
NONE

TPIS Related Resources:

Kidney Allograft Biopsy Diagnostic Categories
Kidney Transplant Topics

Gross Description - Case 1

The specimen is received in media labeled "needle biopsy of kidney" and consists of a single core of pink, soft tissue, 1.5 cm. in length, less than 0.1 cm. in thickness, and entirely submitted for stat processing labeled A.

Microscopic Description - Case 1

BANFF SCORING OF RENAL ALLOGRAFT BIOPSIES

1. Glomerulosclerosis

1.1 Number of glomeruli (13)

1.2 Number globally sclerotic (0)

1.3 Segmental sclerosis ( )YES (X)NO

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

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

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

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

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

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

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

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

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

11. Other Findings None

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)
( ) 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)
( ) Grade 2 (Moderate)(ci1-3, ct1-3, cv1-2)
( ) Grade 3 (Severe)(ci1-3, ct1-3, cv3)

12.3 Drug-associated changes (KDDR): (X)

12.4 Acute tubular necrosis (KDAT): ( )

12.5 Donor diseases (KDDO): ( )

12.3 Other:

( ) Recurrent disease
( ) Subcapsular injury
(X) CMV
( ) Obstruction
( ) Vascular thrombosis

( ) Pyelonephritis
( ) PTLD
( ) Reflux
( ) Miscellaneous

1. Glomerulosclerosis
1.1 Number of glomeruli	(13)
1.2 Number globally sclerotic	(0)
1.3 Segmental sclerosis	( )YES	(X)NO
2. Glomerulitis	(X)0	( )1	( )2	( )3
3. Interstitial inflammation	(X)0	( )1	( )2	( )3
4. Intimal arteritis	(X)0	( )1	( )2	( )3
5. Tubulitis	(X)0	( )1	( )2	( )3
6. Arteriolar hyalin	( )0	(X)1	( )2	( )3
7. Chronic glomerular change	(X)0	( )1	( )2	( )3
8. Interstitial fibrosis	( )0	(X)1	( )2	( )3
9. Tubular atrophy	( )0	(X)1	( )2	( )3
10. Vascular intimal sclerosis	( )0	(X)1	( )2	( )3
11. Other Findings	None
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) ( ) 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) ( ) Grade 2 (Moderate)(ci1-3, ct1-3, cv1-2) ( ) Grade 3 (Severe)(ci1-3, ct1-3, cv3)
12.3 Drug-associated changes (KDDR):	(X)
12.4 Acute tubular necrosis (KDAT):	( )
12.5 Donor diseases (KDDO):	( )
12.3 Other:	( ) Recurrent disease ( ) Subcapsular injury (X) CMV ( ) Obstruction ( ) Vascular thrombosis	( ) Pyelonephritis ( ) PTLD ( ) Reflux ( ) Miscellaneous

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