u0 7 - 1845

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U0 7 - 1845. #844043110 54 y.o. male Deceased donor renal transplant April 18/06 (APCKD) Creat 120  170  515 Being treated for CMV Rejection?. 54 yrs old male Status post deceased donor renal transplant (April 2006) baseline SCr 100-120 He had ESRD secondary to APCKD. - PowerPoint PPT Presentation

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  • U07-1845#84404311054 y.o. maleDeceased donor renal transplant April 18/06 (APCKD)Creat 120 170 515Being treated for CMVRejection?

  • 54 yrs old male

    Status post deceased donor renal transplant (April 2006) baseline SCr 100-120

    He had ESRD secondary to APCKD. CMV D /R, EBV D/ R, Mismatch HLA antigens Medications: Cellcept,Tacrolimus, prednisone Past history: Legally blind (retinitis pigmentosa), HTNDyslipidemia

  • 2-3 weeks ago developed leukopenia, Cellcept dose decreased No change in U/O

    Jan 13 2007 CMV PCR 23,950 copies/ml (peak 55,000 copies/ml)

    18 Jan started on Gancyclovir, 26 Jan SCr 140 next day 178 then 2 days 515

    Hb 105 plate 203 WBC 5.5 LDH normal Bilirubib 11U/A: +3 protein , +1 Hb

  • Doppler u/s: no diastolic flow, patent renal vein U/S: no hydronephrosis Renal scan: severely impaired perfusion

  • IFIgG- Negative.IgA- Negative.IgM- Mild to moderate mesangial staining. Moderate vascular staining.C3- Moderate vascular staining including peritubular capillaries.C1q- Negative.Kappa- Negative.Lambda- Mild vascular staining. Fibrinogen- Moderate interstitial staining. Moderate staining of thrombi in peritubular capillaries and glomerular capillaries.Albumin- Negative.

  • IgM

  • C3

  • C3

  • lambda

  • fibrinogen

  • fibrinogen

  • fibrinogen

  • IFC4d: Moderate linear peritubular capillary staining. Mild to moderate endothelial staining in small arteries.

  • C4d

  • C4d

  • C4d

  • EMIs pending

  • DiagnosisRenal Biopsy:Probable antibody-mediated rejection with thrombotic microangiopathy manifested in glomeruli with extensive glomerular capillary thrombosis and congestion and thrombosis in peritubular capillaries.No evidence of T-cell mediated rejection.Banff scores:G0 CG0 I0 CI0 T0 CT0 V0 CV1 AH0 MM0 PTC0