A 45-Year-Old Man Comes to Clinic for Routine Follow-Up

question 41

Multiple Choice

A 45-year-old man comes to clinic for routine follow-up.  He has a history of end-stage renal disease due to autosomal dominant polycystic kidney disease, and he underwent a deceased-donor kidney transplant 4 years ago.  The patient has hypertension that initially resolved following the transplant but redeveloped 6 months ago.  Review of his recent laboratory studies reveals a progressive increase in serum creatinine levels over the last few months.  Urinalysis is within normal limits.  On ultrasonography, the transplanted kidney is reduced in size.  A biopsy of the graft is most likely to show which of the following?

• A)Dense mononuclear interstitial infiltration
• B)Glomerular crescent formation
• C)Obliterative vascular fibrosis
• D)Tubular hypertrophy and intratubular casts
• E)Vascular fibrinoid necrosis with thrombotic occlusion

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