CASE 30: Thrombotic Microangiopathy

30-year-old man with end stage kidney disease attributed to hypertensive nephrosclerosis. Received a living unrelated kidney transplant 6 months prior to current presentation. Admitted with an oral abscess and acute kidney injury in the setting of dehydration. A biopsy was obtained to address a persistently elevated creatinine despite adequate rehydration.

Allograft biopsy (Figure 112-113) showed signs of thrombotic microangiopathy (image showing a thrombosed glomerulus, H&E 200x). On review, native kidney biopsy (Figure 112-114) also showed features of chronic thrombotic microangiopathy.

It is likely that the current process in the allograft is a recurrent thrombotic microangiopathy. A diagnosis of hypertensive nephrosclerosis in young patients should always be interpreted with caution.