A patient received a kidney transplant 10 days ago. Renal biopsy shows neutrophilic infiltration of glomeruli and capillary walls with complement deposition (C4d positive on peritubular capillaries). This histological pattern is characteristic of:
- A Antibody-mediated acute rejection (ABMR) ✓
- B T-cell-mediated acute rejection (Banff grade IA)
- C Calcineurin inhibitor nephrotoxicity
- D BK polyomavirus nephropathy
Explanation
Antibody-mediated rejection (ABMR) is characterised by the triad of: (1) histological evidence of acute tissue injury (microvascular inflammation — neutrophils in glomeruli/peritubular capillaries, thrombotic microangiopathy), (2) evidence of antibody interaction with endothelium (C4d positivity in peritubular capillaries due to complement activation), and (3) donor-specific antibodies (DSA) in recipient serum. T-cell-mediated rejection (TCMR) shows tubulitis and interstitial infiltrates with lymphocytes (C4d negative); CNI toxicity shows arteriolar hyalinosis; BK nephropathy shows tubular epithelial intranuclear inclusions and SV40 positivity.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.