Case 36
With discussion
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CASE 36 (February 2009)

Clinical information

The patient is a 66-year-old man with end-stage renal disease due to autosomal dominant polycystic kidney disease, on dialysis for 3 years. In 20 previous donor-recipient crossmatches (pre-transplant) there was positivity, and the 21st was negative, then he was transplanted from a cadaveric donor. Induction with OKT3. Immunosuppression: tacrolimus, mycophenolate mophetil, prednisone.

Immediately after transplantation the graft had normal aspect, without signs of thrombosis or hyperacute rejection. However the patient presented oligoanuria in the first two days and needed dialysis. By doopler there was increased intrarenal pressure, but there was not thrombosis signs. At the third day urinary volume increased until 950 cc/day, but he continued to require dialysis. The graft area was not clinically altered. There was not decrease in hematocrit or thrombocytopenia; coagulation tests: normal.

Twelve days after transplantation the patient continued in good general conditions, without fever or pain in the graft area. He remained on dialysis

A renal biopsy was undertaken; see the images.

Figure 1. H&E, X400.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4.H&E, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Methenamine-silver stain, X400

Figure 7. H&E, X400.

Figure 8. H&E, X400.

Figure 9. C4d immunostaining, X400.

Figure 10. C4d immunostaining, X400.

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