ATLAS OF RENAL PATHOLOGY

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Acute Rejection, Type II (Vascular)

Pathology Editor: Agnes Fogo, MD
Medical Photographer: Brent Weedman

 
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Fig 1. Acute vascular rejection is diagnosed by endothelialitis, ie, lymphocytes infiltrating under the endothelium. It often is present in conjunction with acute type I (interstitial) rejection, but may occur without concurrent interstitial rejection. It is thought that humoral mechanisms are pivotal in mediating vascular-type rejection. The biopsy shows minimal subendothelial lymphocytic infiltrate, diagnostic of type II vascular rejection. (Periodic Acid-Schiff, original magnification X100).
 
 
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Fig 2. There is significant endothelialitis with mononuclear cells underneath the endothelium of this large artery, indicative of endothelialitis and type II acute vascular rejection. (Hematoxylin and eosin, original magnification X200).
 
 
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Fig 3. There is endothelial swelling and lymphocytic subendothelial infiltration in this medium size artery, indicative of endothelialitis (type II acute vascular rejection). (Periodic Acid-Schiff, original magnification X200).
 
 
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Fig 4. There is severe subendothelial and transmural lymphocytic infiltrate in this medium size artery, superimposed on changes of chronic rejection, manifest by interstitial fibrosis and glomerulosclerosis and early transplant glomerulopathy. This finding may be present in transplant nephrectomies when immunosuppression has been tapered before graft removal, as in this case. (Jones' Silver Stain, original magnification X100).
 

From the Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
Address author queries to Agnes Fogo, MD, Department of Pathology, Vanderbilt University Medical Center, MCN C-3310, Nashville, TN 37232. E-mail:Agnes.Fogo@vanderbilt.edu
Am J Kidney Dis 35(5):E17, 2000 (available www.ajkd.org)
 Copyright 2000 by the National Kidney Foundation, Inc.

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