L9. Transplantation pathology

Question 1

What characterizes the graft survival

Answer 1

• One year survival has improved in the las 30 yrs
• Long term survival has marginallly improved

Question 2

Graft survival depend on

Answer 2

Source of donor kidney. If form an alive person, the graft has better survival then if it comes from a desceased person

Question 3

Type of acute cellular rejection

Answer 3

• Tubulointerstitial or tubulitis
• Vascular or Endothelialitis
• Glomerular or Transplant glomerulitis

Question 4

Types of Ab mediated rejection

Answer 4

• Tubular injury
• Peritubular capillaritis
• Vascular or transmural arteritis

Question 5

Criteria for acute Ab-mediated renal allograft rejection

Answer 5

• Morphologic evidence
• Immunopathologic evidence
• Serologic evidence of circulating Ab

Cases with only 2 of the 3 criteria are considered suspicious

Question 6

How to distinguish artherosclerosis from arteriopathy of chronic rejection

Answer 6

• Clinical presentation: 20yo pt w/ severe renal disease –> allograft after 8 yrs –> the vessel would look artherosclerosis but it is chronic rejection
• Artherosclerosis more often in alder ppl 70 yo

Question 7

How to distinguish btwn double contouring in glomerulus of chronic rejection vs membranoproliferative disease

Answer 7

• Chronic rejection –> no mesangial cell proliferation or IF immune deposits
• MPD –> mesangial cell proliferation and IF immune deposits

Question 8

Bandd classification of renal allograft rejection

Answer 8

Provides

• Quantitative scoring for acute rejection –> interstitial cellular infiltrates, tubulitis, arteritis and glomerulitis
• Quantitative scoring for chronic rejection –> tubular atrophy, interstitial fibrosis, arteriopathy and glomerulosclerosis

Question 9

What is the most important infection in renal allograft

Answer 9

BK Polyomavirus

Question 10

BK POLYOMAVIRUS NEPHROPATHY (PVN)

Pathogenesis

Allograft biopsy finding:

Therapy

Answer 10

Pathogenesis: Activation and replication of BK virus due to immunosuppressive state

Allograft biopsy finding: tubulointerstitial nephritis w/viral nuclear inclusions. IHC w/ Ab anti SV40 T Ag

Therapy: reduce immunosuppression

Question 11

What are the 3 well known forms of De novo glomerular disease

Answer 11

• Membranous glomerulopath
• Anti-GBM disease
• Focal segmental glomerulosclerosis