Slide Digitization by:

Digital Slide Seminar 6: Day 2 (15.45 - 16.15)

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Renal transplantation pathology - Dr Hemlata Kumari Gnanasegaram

 

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Case 1 History:

- 44-year-old man 

- 11 weeks post cadaveric transplant

- Had previous history of early ATCMR (acute T-cell mediated rejection)

- Now asymptomatic but noted suboptimal graft function - Creatinine 151

- Biopsy done

 

 

 

Case 2 History :

- 52-year-old,

- Day 7 post cadaveric transplant

- Cold ischeamic time - 7 hours

- Noted low urine output

- poor recovery of creatinine

- U/S doppler - good perfussion

- now creatinine - 300

 - Biopsy done

 

 

 

Case 3 History:

- 41-year-old

- LRRT in 2008

- primary disease unknown

- History of ATCMR in 2011

- Treated with Thymoglobulin,

- recurrent history of UTI/ pyelonephritis - 2012-2013

- Creatinine increase of late in past 9months

- Baseline creatinine - 140-180 but now its 230

- Everolimus level within range

- Biopsy done

 

 

 

Case 4 History:

- 29-year-old man

- Living unrelated renal transplant done in 2014

- primary disease unknown

- Baseline Creatinine - 140

- Now creatinine - 190

- Not on MMF because of BK nephropathy, now on Prednisolone & Cyclosporine

- Urine has proteinuriadone

- Biopsy 

 

 

 

Case 5 History:

- 43-year-old lady

- Had cadaveric transplant in 2009

- Donor had hypotension with triple inotrophs

- Had history of CAMR in early post transplant

- Now has HPT and Hydronephrosis mild to moderate

- now rising Creatinine from 150  to 214

- DSA is mildly elevated

- Biopsy done

 

 

 

Case 6 History :

- 55-year-old man

- Has HPT and NODAT

- Post cadaveric transplant in 2015

- Had delayed graft function

- Cold ischemic time 11hours

- intra-op had hypotension

- Had history of repeated infection from AGE to Bronchopneumoniae to Acute appendicitis, 

- finally upon discharge creatinine is 122

- Two days after discharge creatinine increases to 138

- Biopsy done

 

 

 

Case 7 History:

- 56-year-old man

- LRRT in 2014

- Every year there is a rise of creatinine but no biopsy done

- from Creatinine 84(baseline) to 155

- Now presented with proteinuria and RBC in urine

- Biopsy done

 

 

 

Case 8 History:

- 35-year-old lady

- Cadaveric transplant in 2014

- Previous biopsy - had CNI toxicity, hence on lower  dose of CNI

- Baseline Creatinine 120, now creatinine 170 (rising for a few months)

- No proteinuria, but RBC in urine

- suddenly noted sputum AFB positive

- Biopsy done

 

 

 

 

Case 9 History:

- 26-year-old male

- LRRT (Mom to son)

- Primary disease ESRD secondary to reflux nephropathy

- Recently diagnosed as having Ependymoma at 4th ventricle on

   phenytoin (at post transplant)

- Now rising creatinine

- Fk and Everolimus level unstable - probably d/t recent phenytoin usage

- Biopsy done

 

 

 

 

Case 10 History:

- 36-year-old man

- Cadaveric transplanted in 2015

- Delayed graft function

- 4 times biopsy - all ATN

- had CMV disease on treatment

- Donor had AFB positive granuloma in lung (found out later)

- But at time of procurement, kidney looks good

- Anyway recipient was put on Rifampicin & Isoniazid prophylaxis

- At 3 months posttranplant - Creatinine 380

- Biopsy done