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Diagnosis: Acute Antibody Mediated Rejection

Donor antibodies were demonstrated on immunology laboratory. The patient was treated with plasmapheresis, hyperimmune serum and rituximab. Creatinine serum decreased, and renal function is well one month after. Crescents as a morphological expression of rejection are an unusual feature, but we must be aware of the possibility of the formation of these lesions as a result of the immune response.

Crescents can be seen in virtually any severe renal disease. Thus, the question if it is a severe form of immune response against the allograft or an underlying superimposed glomerulonephritis is very difficult. The total lack of immune complexes would certainly be against a GN, and there was no clinical or laboratory (ANCA, ANA) evidence for any underlying condition which would produce GN. Thus we "believe" that the crescents were consequence of severe glomerulitis and humoral rejection.

See the chapter: Kidney Transplantation Pathology (only Spanish version) of our Tutorial.

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References

• Modelli de Andrade LG, Viero RM, Carvalho MF. Acute antibody-mediated rejection of renal transplant associated with cellular crescents: first case report. Transplant Proc. 2011;43(7):2798-9 [PubMed link]

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