Difficult Immunology Question

[Blue Flame]

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A 40-year-old renal transplant patient who received a donor kidney 5 years ago presents to your clinic with a 3 day history of oliguria, lower extremity edema, and nausea. She states that she hasn't taken her immunosuppressive medication for the past week due to a severe infection. Renal biopsy shows a large mononuclear infiltrate in her donated kidney. What is the most likely underlying cause of her condition?

a) Acute rejection
b) Chronic rejection

Narrowed it down to these two choices, but I don't know the actual answer. Any help would be appreciated!

 

[walakin25]

A 40-year-old renal transplant patient who received a donor kidney 5 years ago presents to your clinic with a 3 day history of oliguria, lower extremity edema, and nausea. She states that she hasn't taken her immunosuppressive medication for the past week due to a severe infection. Renal biopsy shows a large mononuclear infiltrate in her donated kidney. What is the most likely underlying cause of her condition?

a) Acute rejection
b) Chronic rejection

Narrowed it down to these two choices, but I don't know the actual answer. Any help would be appreciated!

Acute rejection probably. We give immunosuppressive drugs to inhibit T Cell mediated acute rejection

 

[slz1900]

Acute. You see very few if any inflammatory cells in chronic transplant rejection.

 

[Blue Flame]

Acute rejection probably. We give immunosuppressive drugs to inhibit T Cell mediated acute rejection

Acute. You see very few if any inflammatory cells in chronic transplant rejection.

Thanks guys, I was thinking about these two things as well, but the 5 year part almost threw me off.

 

[MudPhud20XX]

Thanks guys, I was thinking about these two things as well, but the 5 year part almost threw me off.

Wait, so why can't this be chronic? You still get CD4 T cell response which can lead to the "large mononuclear infiltrate," right?

 

[chillaxbro]

Chronic occurs even if you take medication. Medication is to stop the acute rejection / attack from CD8 cells. So if you stop taking medicines after 5 years of taking them, you will start developing an acute attack

 

[Transposony]

Chronic Allograft Nephropathy

Chronic allograft nephropathy represents cumulative and incremental damage to nephrons from time-dependent immunologic and nonimmunologic causes.

Both cellular and humoral components (type II and IV hypersensitivity reactions).

CAN is a term used to describe progressive renal insufficiency with nonspecific pathology in renal transplant recipients. Clinically, CAN is characterized by variable loss of renal function and is frequently associated with hypertension and proteinuria. Numerous risk factors for graft injury have been identified as possible contributors to CAN, including:

Acute injury: donor factors, reperfusion/preservation injury, rejection
Chronic injury: long-term effects of immunosuppressive drugs, poorly controlled blood pressure, dyslipidemia, DM.

 

[Blue Flame]

Chronic Allograft Nephropathy



Both cellular and humoral components (type II and IV hypersensitivity reactions).

Wait, are you saying the answer is acute or chronic rejection? And if it's chronic - based on the info you posted - why would it just happen to occur now after all these years when she stopped her immunosuppressants?

 

[teehees]

I can't see why it wouldn't be chronic.

You are assuming that these drugs work 100% and completely nullify the immune response but it doesn't. If it did then it would be like seeing it for the first time

 

[Blue Flame]

I can't see why it wouldn't be chronic.

You are assuming that these drugs work 100% and completely nullify the immune response but it doesn't. If it did then it would be like seeing it for the first time

Actually, I'm not assuming that at all. Read @chillaxbro's post. Chronic rejection will occur whether she takes or doesn't take the immunosuppressants so it's likely she has chronic rejection to some degree as well, but the question was asking what was specifically causing her current symptoms, which is acute rejection from stopping her immunosuppressants.

 

[Transposony]

Wait, are you saying the answer is acute or chronic rejection? And if it's chronic - based on the info you posted - why would it just happen to occur now after all these years when she stopped her immunosuppressants?

My apologizes for not making it clear.
The answer is Acute rejection and this question stresses the importance of knowing that it can happen number of years following transplant.

My post was in reply to MudPhud20XX's question as to why it can't be chronic rejection. In hindsight I should have quoted his post.