CASE 122 (April 2016)
The patient is a 44-year-old woman, kidney transplanted from deceased donor 3 years before because unknown cause ESKD. In a regular control there was increased serum creatinine: 1.9 mg/dL (6 months earlier, 0.9 mg/dl). Urinalysis without proteinuria or hematuria.
A renal allograft biopsy was done, see the images.
Figure 1. H&E, X100.
Figure 2. H&E, X400.
Figure 3. H&E, X400.
Figure 4. H&E, X200.
Figure 5. H&E, X400.
Figure 6. H&E, X400.
Figure 7. H&E, X400.
Figure 8. H&E, X400.
Figure 9. Methenamine-silver, X400.
Figure 10. Staining for iron (negative), X400.
Figure 11. Fontana-Masson staining, X400.
Direct immunofluorescence for IgA, IgG, IgM, C3, C1q, kappa, and lambda: Negative. C4d: Negative.
What is your diagnosis?