U05-23444

# 810986310• Kidney-pancreas transplant several years

ago.• Recent increase in creatinine with some

proteinuria.• Pancreas working well.

Case summary

• This 45 year man had chronic renal failure pressured to be on the basis of type I diabetes mellitus and after several years of peritoneal dialysis, he received a kidney/pancreas transplant on 31/12/1998

• His post-transplant course was complicated by a number of intra-abdominal problems requiring several laparotomies, bowel resection and ileostomy which was closed on 21/01/2000.

• After all this he ended up with serum creatinine in the 160 – 180 mol/L range with normal glycemia.

• Serum creatinine climbed above 200 mol/L in the Summer of 2005 and this climb continued to ~ 260 mol/L, resulting in a biopsy being performed on 7/12/2005. The biopsy was reported on 6/2/2006 leading to a request for review. Serum glucose levels remain normal. Trace proteinuria has been reported since 2001 with protein:creatinine ratio being variable in the 30 – 80 range.

IF

• IgG- Moderate linear GBM staining.• IgA- Negative.• IgM- Trivial to mild mesangial staining.• C3- Moderate vascular staining.• C1q- Negative. • Kappa- Negative. • Lambda- Negative. • Fibrin- Mild interstitial staining.• Albumin- Moderate linear GBM staining.

IgG

IgM

C3

Fibrin

Albumin

Diagnosis

Renal Biopsy (7 yrs post-transplantation):

-Diffuse glomerulosclerosis with features suggesting recurrent or de novo diabetic nephropathy.-Moderate parenchymal atrophy and scarring.-Slight numbers of paramesangial deposits suggesting superimposed mild IC GN.

Banff scores: g0 cg1 i1 ci2 t0 ct2 v0 cv2 ah2 mm2