Acute T-cell mediated rejection — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

HardRenal TransplantationAcute T-cell mediated rejectionESENeph

Ten days after kidney transplantation, creatinine rises and ultrasound shows no obstruction or perfusion defect. Biopsy shows interstitial inflammation and tubulitis without microvascular inflammation or C4d. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Acute T-cell-mediated rejection

The best answer is “Acute T-cell-mediated rejection”. Interstitial inflammation with tubulitis in the early graft, after excluding competing causes, fits the Banff pattern of acute T-cell-mediated rejection. “Active antibody-mediated rejection” is less appropriate because the defining antibody-associated microvascular features are absent “BK polyomavirus nephropathy” is less appropriate because this usually occurs later and requires viral cytopathic or molecular evidence “Recurrent minimal-change disease” is less appropriate because that produces podocyte injury and nephrotic proteinuria rather than tubulitis “Transplant renal-artery stenosis” is less appropriate because the biopsy and normal perfusion imaging point away from a vascular lesion

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