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 |
Tubular |
- Isometric vacuolization
- Eosinophilic inclusions
- Microcalcifications
|
Vascular |
- Nodular hyaline afferent arteriolar deposits
- Thrombotic microangiopathy
- Occlusive arteriolar change
- Medial degeneration
|
Interstitial |
- Striped or patchy fibrosis
|
Glomerular |
- 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
|
References
- 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.
- 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.
- Racusen L, et al. The Banff 97 working classification of renal allograft pathology. Kidney Int1999;55:713-723
- Randhawa PS, et al. Microvascular changes in renal allografts associated
with FK506 (Tacrolimus) therapy. Am J Surg Pathol 1996;20(3):306-12.
- Randhawa PS, et al. Renal allograft involvement by Epstein-Barr Virus
associated posttransplant lymphoproliferative disease.
Am J Surg Pathol 1996;20(5):563-71.
- Olsen S, et al. Primary acute renal failure ("acute tubular necrosis") in the transplanted kidney: morphology and pathogenesis.Medicine 1989;68:173-187
- 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
- Randhawa PS, et al. Human polyoma virus associated interstitial nephritis in the allograft kidney.Transplantation 1999;67:103-109
- 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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