1 / 16

U0 7 - 174

U0 7 - 174. #230080120 Original disease DIC. Cad Tx 5 years ago. Creat about 90. Not diabetic. U07-00174 24 year old Asian female meningococcemia at age 17 with purpura fulminans, digital infarcts/amputations, and irreversible ARF

alana-coffey
Télécharger la présentation

U0 7 - 174

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. U07-174 #230080120 • Original disease DIC. • Cad Tx 5 years ago. • Creat about 90. • Not diabetic.

  2. U07-00174 • 24 year old Asian female • meningococcemia at age 17 with purpura fulminans, digital infarcts/amputations, and irreversible ARF • deceased donor renal Tx 16 November 2001; 2 yr old pediatric donor • 7% flow PRA against class II HLA, negative against class I HLA • good initial function • maintenance immunosuppression with prednisone, MMF and cyclosporine (2h levels 500-800 µg/L); reduced MMF 500 mg BID due to leukopenia • baseline creatinine 80-95 µM • creep in creatinine to 95-105 µM through 2006; 114 µM in January 2007 • normal urinalysis with protein/creatinine ratio 11 mg/mmol in Oct 2005; trace protein in January 2007 (protein/creatinine ratio pending) • retrospective flow B cell XM positive against donor at time of Tx; currently stronger. T cell XM also positive ?real. Flow PRA 20-35% against class II. • Bx performed which reveals…..

  3. IF • IgG- Mild cytoplasmic staining of interstitial plasma cells. • IgA-Negative. • IgM- Trivial to mild mesangial staining. • C3- Moderate vascular staining. • C1q- Mild to moderate patchy granular staining along the periphery of capillary loops. • Kappa and Lambda- Moderate numbers of interstitial plasma cells with cytoplasmic staining. • Fibrinogen- Mild interstitial staining. • Albumin- Mild hyaline droplet change in tubular cytoplasm.

  4. IgG

  5. IgM

  6. C3

  7. C1q

  8. kappa

  9. lambda

  10. fibrin

  11. albumin

  12. IF • C4d: Moderate linear peritubular capillary staining.

  13. C4d

  14. C4d

  15. EM • is pending

  16. DiagnosisRenal Biopsy (5 years post-Tx): • Ab-mediated rejection with: • diffuse C4d positivity • peritubular capillaritis • glomerular double contours consistent with chronic transplant glomerulopathy • Moderate parenchymal atrophy and scarring • Banff scores: • G1 CG2 I1 CI2 T0 CT2 V0 CV0 AH1 MM1

More Related