pathology of renal transplantation
DESCRIPTION
Luis Humberto Cruz Contreras Residente de Anatomía Patológica. Pathology of renal transplantation. Rechazo – Factor más importante en sobrevida Morfología en biopsias – Correlación clínica. Lesión de preservación. Rechazo hiperagudo. Patología. Rechazo inminente. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/1.jpg)
Pathology of renal transplantation
Luis Humberto Cruz ContrerasResidente de Anatomía Patológica
![Page 2: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/2.jpg)
Rechazo – Factor más importante
en sobrevida
Morfología en biopsias –
Correlación clínica
![Page 3: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/3.jpg)
![Page 4: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/4.jpg)
Antes de Anastomosis a receptor
Epitelio tubular muestra Necrosis y desprendimiento
Epitelio de regeneración aplanado
ME: Edema lisosomal y mitocondrial
Lesión de preservación
![Page 5: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/5.jpg)
Rechazo en min – hasta
24 hrs
Daño Irreversible
Anticuerpos Preformado
s
Rechazo hiperagudo
![Page 6: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/6.jpg)
ABO
Antiendotelio
Antilinfocito
Anti HLA
• Más común • Tipo IgG• HLA 1
Linfocitos T y B
![Page 7: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/7.jpg)
Minutos
Riñones rosa - cianótico y
aspecto moteado
NO orina NO circulación renal
![Page 8: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/8.jpg)
Coagulopatía intrarenal
Microtrombos en arteriolas y glomérulos
Necrosis cortical
Infiltrado mononuclear tardío
ME: Depósito Ig en glomérulo
Patología
![Page 9: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/9.jpg)
![Page 10: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/10.jpg)
Infiltrado inflamatorio glomerular e
intersticial
Hasta 1 hora Post Transplante
Etiología desconocida
Rechazo inminente
![Page 11: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/11.jpg)
Infiltrado mononuclear y PMN•Intersticial •Glomerular
Patología
![Page 12: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/12.jpg)
Deterioro progresivo del transplante
Asociado a cambios patológicos
específicos
Gral. Primeras semanas (hasta meses,
años)
HUMORAL
CELULAR
Rechazo agudo
![Page 13: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/13.jpg)
1990’s
30% Transplantes de cadaver
27% de transplante de donante vivo
37% en segundos transplantes
![Page 14: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/14.jpg)
Infiltrado inflamatorio focal
Tubulitis
Intersticio con edema
> 25% Parénquima renal afectado
Linfocitos, Monocitos, Cél. Plasmática
PMN
Rechazo celular agudo
![Page 15: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/15.jpg)
![Page 16: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/16.jpg)
![Page 17: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/17.jpg)
![Page 18: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/18.jpg)
![Page 19: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/19.jpg)
![Page 20: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/20.jpg)
ME: No aporta al Dx
60 a 80% Linfocitos T CD8
Citotóxicos
![Page 21: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/21.jpg)
Afecta a componente vascular
(Glomerulo y vasos)
Etiología: Anticuerpos Anti-Injerto
(HLA y NO HLA)
Rechazo Humoral agudo
![Page 22: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/22.jpg)
Edema Subendotelial
Necrosis fibrinoide arterial
Depósito de Material Mucoso
Neutrófilos en capilares
peritubulares
![Page 23: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/23.jpg)
Huella de activación inmunológica
Se une a cél. Endotelial y a la membrana
basal
Diagnóstico si,
Está en glomérulo NO en arteria
Si es tejido incluido en parafina
C4d
![Page 24: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/24.jpg)
![Page 25: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/25.jpg)
![Page 26: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/26.jpg)
![Page 27: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/27.jpg)
Rechazo crónico
Pérdida progresiva y lenta de la función
renal
Gral. En Años
Etiología desconocida
Causa más común de pérdida de injerto
Después del 1er año
![Page 28: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/28.jpg)
Creatininia
Proteinuria
Hipertensión
Clinicamente
![Page 29: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/29.jpg)
Glomerulop
atía•Aumento de tamaño•Engrosamiento•Doble contorno•ME: Depósitos subendoteliales
C Vasculares
•Arteriopatia obliterante•Engrosamiento de la íntima•Fibrosis subendotelial•Cambios hialinos
Patología
![Page 30: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/30.jpg)
![Page 31: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/31.jpg)
![Page 32: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/32.jpg)
![Page 33: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/33.jpg)
![Page 34: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/34.jpg)
![Page 35: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/35.jpg)
![Page 36: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/36.jpg)
![Page 37: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/37.jpg)
Toxicidad Medicamentosa
Ciclosporina / Tacrolimus Edema de la íntima Material mucoso en íntima Esclerosis hialina Calcificación tubular Vacuolización tubular
![Page 38: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/38.jpg)
![Page 39: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/39.jpg)
![Page 40: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/40.jpg)
![Page 41: Pathology of renal transplantation](https://reader037.vdocument.in/reader037/viewer/2022102702/56812b35550346895d8f4378/html5/thumbnails/41.jpg)