JE is a 61 year old white male with ESRD of unknown etiology who began chronic hemodialysis in August 1987. His past medical history is significant for Crohn's disease requiring 3 1/2 feet of bowel resection in 1980. He received a cadaveric renal allograft on 8/1/88. The initial post-transplant course was complicated by delayed graft function and his immunosuppressive regimen consisted of prednisone, azathioprine and anti-thymocyte globulin.
He was started on cyclosporine at a time when his urine output was increasing, however within four days he developed decreased urine output and the CsA was discontinued and he was maintained on azathioprine and prednisone.
He was started on cyclosporine at a time when his urine output was increasing, however within four days he developed decreased urine output and the CsA was discontinued and he was maintained on azathioprine and prednisone.
An allograft biopsy was performed on the 22nd post-operative day and repeated on the 40th post-operative day due to continued poor allograft function. A third allograft biopsy was performed on the 65th post-transplant day.
Use the images below to make the diagnosis!
The renal biopsy is shown below:
 |
| Case and histopath courtesy of Dr. Helmut Rennke, BWH/HMS |
