Case 33
With discussion
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CASE 33 (November 2008)

Clinical information

The patient is a 36-year-old man. He developed end-stage renal disease at 34-year-old (unknown cause). After 7 months in hemodialysis he received a cadaveric-donor kidney. Renal function was good the first 8 post-transplantation months. At 9 months serum creatinine increased until 2.3 mg/dL. By ultrasound the graft kidney appear normal. By doppler there are not alterations in main graft vessels.

Immunosuppression: prednisone, cyclosporin, mycophenolate, without changes from the first post-transplantation week. There is not symptoms or clinical signs suggesting a infectious process or other features that explain the disfunction.

Hepatitis B and C viruses negative. Proteinuria: 210 mg/24h; erythrocytes: 3/CAP; no changes suggesting infection.

Acute rejection or cyclosporin toxicity were the presumptive diagnosis. A renal biopsy was undertaken.

Figure 1. H&E, X200.

Figure 2. H&E, X400.

Figure 3. H&E, X200.

Figure 4. H&E, seen with polarized light, X200.

Figure 5. H&E, seen with polarized light, X400.

Figure 6. Methenamine-silver stain, X400.

Figure 7. H&E, X400.

Immunohistochemistry for C4d: negative.

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