Case 29
With discussion
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CASE 29 (July 2008)

Clinical information

The patient is a 30-year-old woman with end-stage renal disease due to focal and segmental glomerulosclerosis. She started hemodialysis and was cadaveric kidney donor transplanted after 3 months in waiting list. The donor was a 20-year-old man head trauma died; he was in intensive care unit for three days previous to organs harvest. Donor renal function was normal until 6 hours previous to kidney extraction when serum creatinine was 2 mg/dL; he does not had known pathologic antecedents. Cold ischemia time: 16 hours.

Serum creatinine reduced from 10.2 mg/dL to 7.2 mg/dL 48 pos-transplantation hours. Diuresis: 1.200 cc in the first 24 hours. Serum creatinine remains stable and does not reduce in the third day. There are not systemic alterations.

Echo-doopler: there is not renal arterial obstruction; intrarenal resistance is increased. Ultrasound does not show urinary obstruction.

With diagnosis of delayed graft function a renal biopsy was undertaken.

See the images of the biopsy.

Figure 1. H&E, X200.

Figure 2. H&E, X200.

Figure 3. H&E, X400.

Figure 4. PAS, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Methenamine-silver stain, X400

Figure 7. Direct immunofluorescence using antiserum to IgM (left) and C3 (right); both were negative in peritubular capillary and interstitium, X400.

Direct immunofluorescence for IgA and IgG: negative. C1q was positive (mild) with the same glomerular disposition of C3 and IgM.
Immunohistochemistry for C4d: Negative.

What is your diagnosis?

See diagnosis and discussion