Haemodialysis access steal syndrome — ESENeph MCQ

Correct answer: A — Active antibody-mediated rejection with microvascular inflammation and C4d

The best answer is “Active antibody-mediated rejection with microvascular inflammation and C4d”. The Banff framework integrates serological evidence of antibody interaction with tissue, microvascular injury and C4d; treatment is transplant-specialist led after competing causes are assessed. “Calcineurin-inhibitor toxicity with arteriolar hyalinosis and striped fibrosis” is less appropriate because this does not explain donor-specific antibody, microvascular inflammation and C4d together “Acute pyelonephritis with neutrophilic tubulointerstitial inflammation” is less appropriate because the defining histological and serological rejection features are present “Recurrent minimal-change disease with diffuse podocyte foot-process effacement” is less appropriate because this would present with podocyte injury and proteinuria rather than C4d-positive microvascular inflammation “Transplant renal-artery stenosis with graft hypoperfusion and hypertension” is less appropriate because vascular imaging rather than these biopsy features would establish that diagnosis

Reference: KDIGO guideline for care of kidney-transplant recipients: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2009-Transplant-Recipient-Guideline-English.pdf