Board question of the week: Transplant-1

1899 3
An 18-year-old white man presents to the renal transplant clinic with complaints of fatigue and nausea for the last week. He was the recipient of a deceased donor kidney transplant 12 months prior and has experienced stable allograft function (Cr 1.2 mg/dL) thereafter. His original renal disease was Alport’s syndrome. His current immunosuppressive regimen consists of tacrolimus and mycophenolate mofetil. He reports strict compliance with this regimen. The nephrologist orders bloodwork:

Bun-50 Cr-5.0 UA-3+ blood 3+ protein dysmorphic RBCs noted
Spot protein/creatinine ratio- 5g/d
C3/C4- normal, FK506 level- 10

Renal transplant ultrasound- no gross abnormality

ANCA pending

Given the worsening renal function, a transplant biopsy is immediately performed. The light microscopy and immunofluorescence appear below:

The answer and explanation will be posted on Monday June 21st

Michael Lattanzio DO

*RFN board questions are meant to help introduce concepts about nephrology related diseases and do not represent actual questions seen on the ABIM exam.

3 comments

  1. RPGN
    Limited form of renal limited ANCA associated vasculitis

  2. RPGN anti-GBM linear immuno

  3. This is going to be of immense help for those who are students in the scope of medicine and also those who are doing research work.

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