Renal Vein Obstruction

This biopsy is from a 60-year-old female, status post renal transplant 5 days prior, who was found to have mechanical obstruction of the renal vein during the surgical revision of the transplanted kidney, without evidence of thrombosis. The biopsy shows marked congestion of the glomerular capillary loops (Fig 1), peritubular capillaries and arterioles, along with margination of neutrophils (Fig 2), interstitial hemorrhage and severe acute tubular injury. C4d is negative and there are no other clinical or morphologic findings suspicious for hyperacute or acute antibody-mediated rejection. Renal vein or artery obstruction is a rare complication of renal transplantation which is usually secondary to thrombosis, especially in the setting of a hypercoagulable state or technical problems with the anastomoses. While no thrombosis was seen in this case, the morphologic findings are similar to those described in the setting of renal vein thrombosis.