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nbme22/Block 3/Question#47 (43.0 difficulty score)
A 10-year-old boy receives a renal transplant ...
Lymphocytes infiltrating tubular epitheliumπŸ”,πŸ“Ί

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submitted by nwinkelmann(311),
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uHtcayeper = tuneism to h,ousr osth remorepfd Ab nsaigta tgrfa dlhaeoenitl lecl Ag = mlitmponec cva,ttaioni dhlntoealie am,aged fnaiiolmmtna tnhwi(i hte eutssi, OTN i,sutte)niirmt ottcigln c,dceasa ihcisemc scosinre nad .osrobsthmi imoltshp/ptsa/Krtc/utyiipbRnm.rA/

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submitted by niboonsh(366),
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Tsih si a aces of cuaet attnlparns e.eornjtci wseke ot nhtoms ferat hte ntnatar,spl neptceiir d8c /arndo 4cd t scell ear iedatacvt atnigas eht ronod (a pyte 4 S)RH dan teh roodn tatrss igkanm ebtnsiiado stianag eht ntnstlarpa. hsTi tnprssee sa a ilcavistsu thwi esden triilisteatn hpcyitcmyol ft.anliretis (80F21A gp )911

ls3076  Actually was confused about this due to a UW explanation. UW said acute txp rejection has two types - humoral and humoral and cellular. Humoral has Neutrophilic infiltrate + necrotizing vasculitis while cellular has lymphocytosis. Can anyone simplify/explain this please? +3  
apurva  We usually look for c4d complement for humoral response in acute graft rejection. Because c4d makes covalent bond with the endothelium can can be found on staining because it is long lasting. +  

submitted by adisdiadochokinetic(78),
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naC eaonyn pexailn yhw rusbiFo srsca htiw slampa eslcl is nto teh oecrctr n?wears

osler_weber_rendu  Exactly. Three months can fall under chronic rejection as well. FA pg 119 states "interstitial fibrosis". Chronic rejection is predominantly Bcell mediated (plasma cells). +1  
beto  chornic rejection > 6 month acute < 6 month +5  
beto  also there are no B cells in the site of fibrosis. humoral response due to antibody themself,not by direct B cells response +3  

submitted by mcl(618),
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apeg 911 aP FntiteA si ertipnseng nhstom etfra hte rnltpsaatn, hhicw menas ti 'tacn eb eychtpraue nuless he odpteps tanigk ihs tnpsnimos.aeupmussr otHc/nreuVh/iAGcc isaesed rea tidemdea by T cesll for the tmos tpra (I i)hk,tn os ihts olduw naem ythopcmcyil sitlfani.ter

usmleuser007  It is very unlikely to be GVH disease b/c it's more common if the host is suppressed as in if host had ablated bone marrow. (FA states that it's more common with bone marrow & liver transplants) +3  
usmleuser007  any one care to explain why fibrous scars with plasma cells not a good option?... +3  

submitted by snoochi95(3),
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seDo onanye oknw hwy iths si otn rhnicoC rtceejon?i Tyeh hbot tfi tnhiiw the mtei amfr.e

submitted by lowyield(31),

I think the three most reasonable answers can be put into the different boxes of rejection

Glomerular neutrophils and necrosis->hyperacute (? I usually just think neutrophils are the earlier onset things)

Lymphocytes infiltrating tubular epithelium-> Acute [<6 mo]

Fibrous scars and plasma cells ->these two key words seem more like chronic etiologies (this extends beyond graft rejection)

My best guess at the other options are:

Arteriolar C3 deposition- some sort of nephritic syndrome, whether it's SLE, PSGN etc.

Dilation of Bowman's space-post-renal obstruction

RBC casts- nephritic something something, basically it's glomerular rather than interstitial bleeding

Subcortical necrosis- diffuse cortical necrosis caused by obstetric catastrophes/septic shock/DIC etc.