Final Diagnosis (Case 8)

1. TUBULAR AND MYOCYTE VACUOLIZATION (See comment).
2. TUBULAR AND PERITUBULAR CALCIFICATIONS (See comment).

Tubular & myocyte vacuolization is a morphologic criterion for drug toxicity, provided other ischemic & metabolic insults have been reasonably excluded.

Calcification in the allograft kidney is generally of the dystrophic type, and reflects prior injury due to ischemia, drug toxicity or rejection. A small proportion of cases result from hyperparathyroidism occurring secondarily to end-stage renal disease in the native kidney. Correlation with the clinical findings and serum biochemistry is suggested.

This biopsy also contains a minimal interstitial infiltrate which does not qualify for the diagnosis of acute rejection. However, the sample contains only 7 glomeruli, and 1 artery, and falls short of the Banff criteria for specimen adequacy. If the patient' s clinical status continues to deteriorate, a repeat sample may be helpful.

Previous Biopsies on this Patient:
None

TPIS Related Resources:
Kidney Transplant Topics

Gross Description - Case 8

Microscopic Description - Case 1

(2 H&E, 1 PAS)
1. Glomerulosclerosis
1.1 Number of glomeruli . . . . .(7 )
1.2 Number globally sclerotic . .(0 )
1.3 Segmental sclerosis . . . . .( )YES(x )NO

2. Glomerulitis(g). . . . . . . . . .(x )0 ( )1 ( )2 ( )3

3. Interstitial inflammation(i) . . .(x )0 (x )1 ( )2 ( )3
(check if present) . . . . . . .( )Neutrophils( )Eosinophils

4. Intimal arteritis(v) . . . . . . .(x )0 ( )1 ( )2 ( )3
( )Not evaluable 5. Tubulitis(t) . . . . . . . . . . .(x )0 (x )1 ( )2 ( )3

6. Arteriolar hyalin(ah). . . . . . .(x )0 ( )1 ( )2 ( )3
( )Not evaluable Nodular form . . . . . . . . . . .( )YES( )NO

7. Chronic glomerular change(cg). . .(x )0 ( )1 ( )2 ( )3
7b. Mesangial matrix increase (mm) . .(x)0 ( )1 ( )2 ( )3

8. Interstitial fibrosis(ci). . . . .(x )0 ( )1 ( )2 ( )3

9. Tubular atrophy(ct). . . . . . . .(x )0 ( )1 ( )2 ( )3

10. Vascular intimal sclerosis(cv) . .(x )0 ( )1 ( )2 ( )3
( )Not evaluable 10b. Number of arteries with internal elastic lamina: (1 )

11. Other findings:

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 IIA (i1-3, t0-3, v1)
( )KDAR2B: Type 2B (i1-3, t0-3, v2)
( )KDAR3: Type III (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
(x ) KDDR: Tubular and/or myocyte vacuolization c/w drug-associated changes.
(x ) KDAT: Acute tubular necrosis.
( ) KDDO: Donor disease.
Other:
( ) Recurrent disease (specify)
( ) Subcapsular injury ( )Pyelonephritis
( ) CMV ( )PTLD
( ) Obstruction ( )Reflux
p ( ) Vascular thrombosis (specify) (x ) Miscellaneous