23529              REJECTED RENAL TRANSPLANT

This 51 year old woman had Henoch-Scholein purpura in 1965 following acute tonsillitis and quinsy.  She presented 4 months later with nocturia and was shown to have proteinuria.  Renal biopsy showed progressive glomerulonephritis.  She gradually deteriorated into chronic renal failure, and required renal transplant in January 1972.  Unfortunately the kidney was rejected and haemodialysis for her renal failure was resumed.

The specimen consists of a kidney (12 cms x 6 cms).  Externally it appears swollen with massive subcapsular haemorrhage.  On section there is marked interstitial cortical haemorrhage particularly in the subcapsular region.  Most of the pyramids are spared.  The calyces also have haemorrhages beneath their surfaces.  Histology shows acute vascular congestion with large irregular areas of acute haemorrhagic infarction.  The intervening renal tissue appears remarkably healthy, but some tubules are dilated and contain hyaline material and there are some foci of tubular atrophy and early fibrosis.  Glomeruli are relatively acellular and some loops are thickened and others are thrombosed.  Thrombi are present in some small vessels.