Mr. Douglas, a 55-year-old male, has a history of end-stage renal disease secondary to chronic glomerulonephritis. Five years ago, he underwent a successful renal transplant. However, he has recently experienced a decline in renal function, manifesting as fatigue, shortness of breath, swelling in his legs and ankles, decreased urine output, elevated blood pressure, nausea, and vomiting. Physical examination reveals elevated blood pressure, periorbital edema, decreased breath sounds, peripheral edema, and tenderness over the transplanted kidney. Laboratory tests show elevated serum creatinine, blood urea nitrogen, and decreased estimated glomerular filtration rate. Electrolyte abnormalities, including hyperkalemia and hyponatremia, are also present. Additionally, anemia and elevated inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate are noted. Based on these findings, a diagnosis of chronic renal transplant rejection is made. A kidney biopsy is also ordered. Which of the following best describes the histological picture seen in chronic renal transplant rejection?
A 72 year-old female came to your office complaining of fever, fatigue, lower abdominal pain, and decreased urine output. Her past medical history is significant for dialysis dependent end-stage renal disease for 12 years and a renal transplantation 9 months ago. Your physical examination is significant for pain on the right lower abdomen. In consultation with her nephrologist, you ordered some laboratory studies and a renal transplant biopsy. Laboratory tests came positive for circulating donor-specific antibodies. In biopsy, histological examination showed microvascular inflammation, intimal arteritis, acute thrombotic microangiopathy, acute tubular injury, linear C4d staining in peritubular capillaries, and de novo glomerulonephritis. This patient received treatment and her condition improved well with plasmapheresis. She asked for your advice regarding vaccinations. Of the following, which is the best advice to give her?
A 72 year-old female came to your office complaining of fever, fatigue, lower abdominal pain, and decreased urine output. Her past medical history is significant for dialysis dependent end-stage renal disease for 12 years and a renal transplantation 9 months ago. Your physical examination is significant for pain on the right lower abdomen. In consultation with her nephrologist, you ordered some laboratory studies and a renal transplant biopsy. Laboratory tests came positive for circulating donor-specific antibodies. In biopsy, histological examination showed microvascular inflammation, intimal arteritis, acute thrombotic microangiopathy, acute tubular injury, linear C4d staining in peritubular capillaries, and de novo glomerulonephritis. What is the most common treatment for this transplant rejection?
A 72 year-old female came to your office complaining of fever, fatigue, lower abdominal pain, and decreased urine output. Her past medical history is significant for dialysis dependent end-stage renal disease for 12 years and a renal transplantation 9 months ago. Your physical examination is significant for pain on the right lower abdomen. In consultation with her nephrologist, you ordered some laboratory studies and a renal transplant biopsy. As you await the test results, she reports she is concerned about transplant rejection. Regarding transplant rejection, which of the following is a correct statement?
A 45 year-old male developed fever, malaise, uncontrollable hypertension, oliguria and tenderness over the transplant site four months after receiving a renal transplant. His serum creatinine is elevated and there are red blood cell casts and elevated proteins in his urine. A renal transplant biopsy established that this patient had developed acute T-cell mediated transplant rejection. What is the first-line treatment for this condition?
A 45 year-old male developed fever, malaise, uncontrollable hypertension, oliguria and tenderness over the transplant site four months after receiving a renal transplant. His serum creatinine is elevated and there are red blood cell casts and elevated proteins in his urine. Regarding transplant renal biopsy, which of the following is true?
A 54-year old male developed end-stage renal disease secondary to diabetes. He received a kidney transplant from a living relative. The transplant functioned well with significant improvement in his well being. However, 4 months after transplantation, he noticed tenderness in his groin over the site of transplant, fever, malaise, oliguria, and decreased urine output. Which of the following is the most valuable prognostic indicator in this patient?
A 62 year-old male with end-stage renal disease expressed interest in receiving a renal transplant, and being taken to the operation theater for transplant surgery. The kidney is placed in the lower abdomen and blood supply is established with the iliac vessels. As the surgeons connect the donor kidney to the patient’s bladder, the patient’s temperature rose to 102 F, blood pressure dropped to 80/40 mmHg and heart rate has increased to 120 beats per minute. The transplanted kidney appears cyanotic, hemorrhagic, necrotic and mottled. You suspect hyperacute rejection in this patient. What is the best treatment for this patient who is diagnosed with hyperacute rejection?
A 62 year-old male with end-stage renal disease expressed interest in receiving a renal transplant, and being taken to the operation theater for transplant surgery. The kidney is placed in the lower abdomen and blood supply is established with the iliac vessels. As the surgeons connect the donor kidney to the patient’s bladder, the patient’s temperature rose to 102 F, blood pressure dropped to 80/40 mmHg and heart rate has increased to 120 beats per minute. The transplanted kidney appears cyanotic, hemorrhagic, necrotic and mottled. You suspect hyperacute rejection in this patient. Of the following, what is the most likely mechanism in hyperacute rejection?
A 62 year-old male with end-stage renal disease expressed interest in receiving a renal transplant, and being taken to the operation theater for transplant surgery. The kidney is placed in the lower abdomen and blood supply is established with the iliac vessels. As the surgeons connect the donor kidney to the patient’s bladder, the patient’s temperature rose to 102 F, blood pressure dropped to 80/40 mmHg and heart rate has increased to 120 beats per minute. The transplanted kidney appears cyanotic, hemorrhagic, necrotic and mottled. You suspect hyperacute rejection in this patient. Of the following, which type of hypersensitivity is observed in hyperacute rejection?
