USCAP EVENING RENAL PATHOLOGY SPECIALY CONFERENCE
ATLANTA
Wednesday March 7, 2001
Moderator V. D'Agati

Clinical Presentation. A 56 year old woman developed chronic renal failure due to autosomal dominant polycystic disease. She received a living related renal allograft from her 26 year old daughter. Cross match showed no detectable anti-donor antibodies pre-transplant (anti-globulin microcytotoxicity test). She was treated with Cyclosporin A (CsA), prednisone and azathioprine. The graft had excellent function until post-operative day 7 when the creatinine rose from 1.4 to 2.2 mg/dl. Blood CsA was 464 ng/ml, platelets 208,000/mm3, and hematocrit 31%. A renal scan showed diminished perfusion, consistent with rejection. An ultrasound was negative for obstruction. A renal biopsy was performed on day 7 (Bx1). Immunofluorescence showed scanty granular staining for C3 in the mesangium and vessels. Other stains were unremarkable (IgG, IgM, IgA, fibrin). The patient was treated with pulse steroids and anti-T cell antibody. The creatinine continued to rise to 5.2 mg/dl on day 12 and a second renal biopsy was performed (Bx 2).

Material submitted: 4 kodachromes

Bx 1: H&E stained sections: 2 panels, cortex and medulla
Bx 1: Electron micrographs (2 panels)
Bx 2: Low power H&E of cortex, with artery as insert
Bx 2: Periodic acid-Schiff stain of glomerulus and H&E stained section of cortex at high power