Case 54
With discussion
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CASE 54 (August 2010)

Clinical information

A 33-year-old woman with ESRD of unknown cause was kidney transplanted from a deceased woman donor who died of hemorrhagic cerebrovascular disease. The donor had antecedent of systemic hypertension on medical treatment; she was in intensive care unit 48 hours before of diagnosis of brain death; the blood pressure was high and difficult to control; serum creatinine at admission: 1.0 mg/dL; it increased until 1.5 mg/dL after 48 hours in intensive care unit.

After trasnplantation: diuresis 5.6 liters the firts day, but serum creatine did not decrease; on the 6th day she continued on dialysis. A renal biopsy was performed (Figures 1-7).

The mate receptor (from de same donor) also had delayed graft function, continued on dialysis and was graft biopsied on the 7th day (figures 8-11).

C4d in both biopsies: Negative.

See the microscopic images.

Figure 1. H&E, X200.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. Methenamine-silver stain, X400.

Figure 5. Methenamine-silver stain, X400.

Figure 6. H&E , X400.

Figure 7. Masson's trichrome stain, X400.

Figure 8. The mate kidney. H&E, X400.

Figure 9. The mate kidney. Left: H&E, X400. Right: Methenamine-silver stain, X400.

Figure 10. The mate kidney. Left: Masson's trichrome stain,X400. Right: Methenamine-silver stain, X400.

Figure 11. The mate kidney. Left: H&E, X400. Right: Masson's trichrome stain, X400.

Wath is your diagnosis?

See diagnosis and discussion