Case 11
With discussion
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Clinical information

A 44 years-old woman with unknown cause end-stage-renal disease (presumably "chronic glomerulonephritis") was transplanted, after 4 months in hemodialysis, from a brain-dead donor with cranioencephalic trauma.

The graft function was well the first three weeks. At 23 post-transplant day serum creatinine was 1.5 mg/dL, and it rises to 3.0 mg/dL at 30 post-transplant day. There was not proteinuria or hematuria. Urinary volume: 1,500 cc/d. Doppler sonography did not show increase of the vascular resistance. Steroid boluses were administrated without response.

A renal biopsy was undertaken. See the images.

Figure 1. H&E, X200.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. H&E, X400.

Immunohistochemistry for C4d was negative.

What is your diagnosis?

See diagnosis and discussion