CASE 191 (January 2022)

Clinical information

A 32-year-old woman, kidney transplant 6 months earlier, presents elevated serum creatinine: 1.9 mg/dL (baseline 1.0 mg/dL). The patient is asymptomatic. She does not report fever. There is no edema or hypertension. Cause of end-stage kidney disease: unknown. Cadaveric donor transplant with immediate function and normalization of creatinine on the third day, without subsequent elevations of creatinine until this last control. Immunosuppression: tacrolimus - mycophenolate - prednisone.

The kidney graft is biopsied, look at the images.

Figure 1. H&E, X400. Multiple foci of interstitial inflammation and tubulitis.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. H&E, X400. Note the characteristics of the cell in the central part of the image.

Figure 5. H&E, X400. The same cell from the previous image in another serial section.

Figure 6. H&E, X400.

Figure 7. H&E, X400. Glomeruli without specific alterations.

Figure 8. PAS, X400.

Figure 9. Masson's trichrome stain, X400.

Figure 10. Methenamine-silver stain, X400. Inflammatory destruction of tubules.

Figure 11. PAS, X400.

Immunohistochemistry for C4d and Poliomavirus: Negative.

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