Digital Slide Seminar 6: Day 2 (15.45 - 16.15)
​​​
Renal transplantation pathology - Dr Hemlata Kumari Gnanasegaram
​
​​
Case 1 History:
- 44-year-old man
- 11 weeks post cadaveric transplant
- Had previous history of early ATCMR (acute T-cell mediated rejection)
- Now asymptomatic but noted suboptimal graft function - Creatinine 151
- Biopsy done
Case 2 History :
- 52-year-old,
- Day 7 post cadaveric transplant
- Cold ischeamic time - 7 hours
- Noted low urine output
- poor recovery of creatinine
- U/S doppler - good perfussion
- now creatinine - 300
- Biopsy done
Case 3 History:
- 41-year-old
- LRRT in 2008
- primary disease unknown
- History of ATCMR in 2011
- Treated with Thymoglobulin,
- recurrent history of UTI/ pyelonephritis - 2012-2013
- Creatinine increase of late in past 9months
- Baseline creatinine - 140-180 but now its 230
- Everolimus level within range
- Biopsy done
Case 4 History:
- 29-year-old man
- Living unrelated renal transplant done in 2014
- primary disease unknown
- Baseline Creatinine - 140
- Now creatinine - 190
- Not on MMF because of BK nephropathy, now on Prednisolone & Cyclosporine
- Urine has proteinuriadone
- Biopsy
Case 5 History:
- 43-year-old lady
- Had cadaveric transplant in 2009
- Donor had hypotension with triple inotrophs
- Had history of CAMR in early post transplant
- Now has HPT and Hydronephrosis mild to moderate
- now rising Creatinine from 150 to 214
- DSA is mildly elevated
- Biopsy done
Case 6 History :
- 55-year-old man
- Has HPT and NODAT
- Post cadaveric transplant in 2015
- Had delayed graft function
- Cold ischemic time 11hours
- intra-op had hypotension
- Had history of repeated infection from AGE to Bronchopneumoniae to Acute appendicitis,
- finally upon discharge creatinine is 122
- Two days after discharge creatinine increases to 138
- Biopsy done
Case 7 History:
- 56-year-old man
- LRRT in 2014
- Every year there is a rise of creatinine but no biopsy done
- from Creatinine 84(baseline) to 155
- Now presented with proteinuria and RBC in urine
- Biopsy done
Case 8 History:
- 35-year-old lady
- Cadaveric transplant in 2014
- Previous biopsy - had CNI toxicity, hence on lower dose of CNI
- Baseline Creatinine 120, now creatinine 170 (rising for a few months)
- No proteinuria, but RBC in urine
- suddenly noted sputum AFB positive
- Biopsy done
-
Case 8 - HE
-
Case 8 - MT
-
Case 8 - PAAG
-
Case 8 - PAS
-
Case 8 - U32 SV40
-
Case 8 - U175 C4D
-
Case 8 - U361 CMV
Case 9 History:
- 26-year-old male
- LRRT (Mom to son)
- Primary disease ESRD secondary to reflux nephropathy
- Recently diagnosed as having Ependymoma at 4th ventricle on
phenytoin (at post transplant)
- Now rising creatinine
- Fk and Everolimus level unstable - probably d/t recent phenytoin usage
- Biopsy done
Case 10 History:
- 36-year-old man
- Cadaveric transplanted in 2015
- Delayed graft function
- 4 times biopsy - all ATN
- had CMV disease on treatment
- Donor had AFB positive granuloma in lung (found out later)
- But at time of procurement, kidney looks good
- Anyway recipient was put on Rifampicin & Isoniazid prophylaxis
- At 3 months posttranplant - Creatinine 380
- Biopsy done