{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T09:45:08Z","timestamp":1694511908710},"reference-count":18,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2015,6,2]],"date-time":"2015-06-02T00:00:00Z","timestamp":1433203200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Herein, we report a complicated case of acute <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>\u2010cell\u2010mediated rejection (<jats:styled-content style=\"fixed-case\">ACR<\/jats:styled-content>) accompanied by <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>4d\u2010negative acute antibody\u2010mediated rejection (<jats:styled-content style=\"fixed-case\">AMR<\/jats:styled-content>) and cell debris in tubulus. A 32 year\u2010old male was admitted for an episode biopsy with a serum creatinine (<jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>r) level of 1.83\u2009mg\/d<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content> and pyuria (20\u201329 white blood cells per high power field) 49 days following kidney transplantation. Histological features included three distinct entities, mainly, in one of the three specimens: 1) focal aggressive tubulointerstitial inflammatory cell infiltration with moderate tubulitis, 2) inflammatory cell infiltration in peritubular capillaries (including neutrophils) and glomerular capillaries, and 3) cell debris consisting mainly of neutrophils in tubulus. Laboratory examination revealed evidence of non\u2010human leukocyte antigen donor\u2010specific antibodies. However, urinary culture and gram staining were negative. Considering both the histological and laboratory findings, the patient was diagnosed with <jats:styled-content style=\"fixed-case\">ACR<\/jats:styled-content> accompanied by <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>4d\u2010negative <jats:styled-content style=\"fixed-case\">AMR<\/jats:styled-content> and suspicion of a urinary tract infection (<jats:styled-content style=\"fixed-case\">UTI<\/jats:styled-content>). The patient was treated for three consecutive days with steroid pulse therapy. The patient's <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>r level decreased to \u223c1.5\u2009mg\/d<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content> following treatment and did not increase thereafter. A second biopsy 133 days following kidney transplantation showed an excellent response to treatment and revealed no evidence of rejection. This case report demonstrates the difficulty in the diagnosis of, and therapy for, the complicated pathological findings of <jats:styled-content style=\"fixed-case\">ACR<\/jats:styled-content>, <jats:styled-content style=\"fixed-case\">AMR<\/jats:styled-content> and suspicion of a <jats:styled-content style=\"fixed-case\">UTI<\/jats:styled-content>.<\/jats:p>","DOI":"10.1111\/nep.12466","type":"journal-article","created":{"date-parts":[[2015,6,2]],"date-time":"2015-06-02T23:42:53Z","timestamp":1433288573000},"page":"70-74","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute <scp>T<\/scp>\u2009cell\u2010mediated rejection accompanied by <scp>C<\/scp>4d\u2010negative acute antibody\u2010mediated rejection and cell debris in tubulus: A case report"],"prefix":"10.1111","volume":"20","author":[{"given":"Tsuyoshi","family":"Takamura","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izumi","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuyuki","family":"Nakada","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruki","family":"Katsumata","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takafumi","family":"Yamakawa","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maiko","family":"Furuya","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aki","family":"Mafune","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akimitsu","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yudo","family":"Tanno","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Miki","sequence":"additional","affiliation":[{"name":"Department of Urology The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ichiro","family":"Ohkido","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuo","family":"Tsuboi","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyasu","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Atsugi City Hospital  Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Yokoo","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,6,2]]},"reference":[{"key":"e_1_2_5_2_1","first-page":"81","article-title":"Impact of acute rejection and new\u2010onset diabetes on long\u2010term transplant graft and patient survival","volume":"3","author":"Cole EH","year":"2008","journal-title":"Clin. 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