Rarely does the glomerular damage extend to the pint of forming mesangiolysis or microaneurysm although it is common to have segmental sclerosis. On performing immunofluorescence, deposits of C3, IgM as well as IgG are located in the capillary walls and in mesangial regions with varying intensity. A combination of the above changes in the glomerular is referred to as chronic transplant glomerulopathy characterizing chronic kidney allograft rejection (Cohen, 2007).
In the tubule-interstitium region, a number of non-specific changes are identified with the most pronounced changes being marked tubular drop-out as well as pronounced atrophy. While ossification is hardly seen, cases of calcified fibrotic interstitium are not uncommon. An examination of the peritubular capillaries shows some level of abnormality with over half of chronic rejection cases showing C4d deposition, a clear indicator of humoral role in chronic rejection.
Peritubular capillaries present with multilayered basement membranes which is a product of new basement membrane that is deposited during the repair process of endothelial cells which are damaged from time to time. The coexistence of chronic transplant glomerulopathy and C4d is sometimes linked to the formation of the multilayered basement membranes.
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