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

Clinical presentation. A 47 year old man with a history of polycystic kidney disease was treated with cadaveric renal transplantation. His immunosuppressive regime consisted of cyclosporine, azathioprine, and prednisone. On post-transplant day 10, rising serum creatinine prompted a biopsy, which showed moderate acute rejection without intimal arteritis. There was no clinical response to additional steroids, tacrolimus 'rescue therapy", or anti--thymocyte globulin. Follow-up biopsies on days 19, 29 and 30 showed progressive graft injury leading to focal necrosis of the renal parenchyma. Hemodialysis was started followed by an allograft nephrectomy on day 42. The patient died 4 days later of multisystemic failure, which was clinically felt to be due to post-operative sepsis leading to disseminated intravascular coagulation and intracranial hemorrhage.

Material submitted: 3 kodachromes of the allograft nephrectomy
Figure 1: gross specimen
Figure 2: Low power photomicrograph from grossly visible nodule
Figure 3: High power H&E