A 45-year-old man comes to clinic for routine follow-up. He has a history of end-stage renal disease due to autosomal dominant polycystic kidney disease, and he underwent a deceased-donor kidney transplant 4 years ago. The patient has hypertension that initially resolved following the transplant but redeveloped 6 months ago. Review of his recent laboratory studies reveals a progressive increase in serum creatinine levels over the last few months. Urinalysis is within normal limits. On ultrasonography, the transplanted kidney is reduced in size. A biopsy of the graft is most likely to show which of the following?

Question

A 45-year-old man comes to clinic for routine follow-up.  He has a history of end-stage renal disease due to autosomal dominant polycystic kidney disease, and he underwent a deceased-donor kidney transplant 4 years ago.  The patient has hypertension that initially resolved following the transplant but redeveloped 6 months ago.  Review of his recent laboratory studies reveals a progressive increase in serum creatinine levels over the last few months.  Urinalysis is within normal limits.  On ultrasonography, the transplanted kidney is reduced in size.  A biopsy of the graft is most likely to show which of the following?

Quizplus · Accepted Answer

Eductional Objective: Chronic renal allograft rejection manifests months to years after a transplant and presents with worsening hypertension and a gradual decline in renal function.  It involves a chronic cell-mediated and antibody-mediated response against donor antigens and leads to obliterative vascular wall thickening, tubular atrophy, and interstitial fibrosis.  The process is usually irreversible and eventually leads to graft failure.

A 45-Year-Old Man Comes to Clinic for Routine Follow-Up