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Case 9
Presented by: Heinz Regele
Clinical History
Patient H.H., male, 64 years old at time of biopsy
Native kidney disease: unknown, no Bx available
1st dialysis 1986
1st renal Tx in 1988
Tx failure in 1995 (chronic rejection and membranous glomerulonephritis)
Dialysis from 1995-1999
07/99: 2nd renal Tx, 95% PRA (panel reactive antibodies). Desensitisation treatment consisting of pre- and post-Tx immunoadsorption and additional induction therapy with ALG was started according to a local protocol.
The patient suffered from delayed graft function but could be discharged from the hospital at 3 weeks post Tx with SCr of 1,2mg%
12/2001: Tx-Bx (SCr 2,2mg%): Banff borderline lesion.
2003: increasing proteinuria, an allograft biopsy did not contain diagnostically adequate tissue.
02/2004: Tx-Bx performed during surgical intervention required for perirenal hematoma causing hydronephrosis and oliguria (patient is on oral anticoagulation (Cumarin) for atrial fibrillations)
Other clinical data at time of Bx:
SCr 4,9mg%
Proteinuria 7g/24h
Hepatitis C with high virus load
03/2004: Patient returns to dialysis
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Membranous GN of the allograft (most likely recurrent). Cholesterol embolism. No convincing evidence for currently active rejection (g2, i1, t0, ah0, cg0, ci2, ct2, mm2)
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28.12.2007 |
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