CASE 3
Luis Salinas-Madrigal MD
Department of Pathology
St Louis University School of Medicine, St Louis MO
CLINICAL HISTORY
The patient is a 28 year old African-American college student who is status-post cadaveric renal transplant on 4/26/01 due to end-stage renal disease reportedly related to focal segmental glomerulosclerosis (no further histological details).
Eight days after the transplant he presented with bloating, abdominal pain, and absence of bowel movements. He was admitted for a wound exploration and renal biopsy. At that time serum creatinine was 3.6. A renal biopsy on 5/11/01 showed thrombotic microangiopathy. He was discharged home on Norvasc, Clonidine, Pericolace, Colace, Mycelex, Labetolol, Prevacid, Cellcept, Deltasone, Iron sulfate, Reglan and Rocephin.
After a poorly documented interval of 3 years, the patient returned to the hospital with elevated BUN and creatinine (41 mg/dl and 3.7 mg/dl, respectively) on 6/30/04. At this time, CBC showed 3.57 mill/mm 3 red cells, hemoglobin 9.0 g/dl, hematocrit 29.8%, and normal white blood cells and platelets. He also had proteinuria of 3.5 g/24 hrs. A renal biopsy was obtained (included in this session). HLA Class I and Class II antibodies and T-cell TWA and B-cell TWA Class I HAD been negative.
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