renal transplant, chronic vascular rejection ICD-10: T86.1
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Frau, 50 J. Nephrektomie wegen Transplantatversagen 5 Monate nach
Transplantation auf Grund glomerulonephritischer Schrumpfnieren
- Glomerula verquollen
- Tubuli fehlen weitgehend
- Ausgedehnte, schwere interstitielle Fibrose
- Hochgradige, zellarme Verdickung der Intima der Aa.
interlobares und arcuatae
mit hochgradig eingeengtem Lumen
- Mehrere frische Niereninfarkte
Pathogenese:
Immunologische Ueberempfindlichkeitsreaktion Typ IV
Klinik:
Transplantatversagen, d.h. Niereninsuffizienz, generalisierte Oedeme
Differentialdiagnose:
Niereninfarkt unklarer Aetiologie
50-year-old female underwent nephrectomy because of transplant failure 5 months following renal transplantation. The latter had been initially performed due to end-stage chronic glomerulonephritis.
- Extensive fresh infarct.
- Medium-sized and large caliber arteries exhibit a profound thickening of the wall consisting of a concentric, onion-skin intimal fibroplasia leading to complete arterial occlusion.
- Outside of infarct, severe interstitial fibrosis (Fibrose) with loss of renal parenchyma; tubuli are largely missing, glomeruli are destroyed (Glomerula).
Chronic transplant arteriopathy is the most specific morphologic lesion of chronic rejection.
Mixed, humoral and cellular immune mechanisms and other factors (e.g. calcineurin inhibitor toxicity) contribute to chronic rejection.
Clinical findings: Transplant failure leads to symptoms of chronic renal insufficiency (e.g. generalized edemas).