INDIVIDUAL WORK: SYSTEM ASSESSMENT

“Urinary and Renal’

BAHASA INGGRIS KEPERAWATAN

oleh:
Annisa Zahra Mustofavi
192310101131
Kelas D 2019

PROGRAM STUDI ILMU KEPERAWATAN

FAKULTAS KEPERAWATAN
UNIVERSITAS JEMBER
2020
 RESUME

Antibody-Mediated Rejection (AMR) is a significant and challenge for

long term graft survival in kidney transplantation. The major mechanism of AMR
is activation of classical complement pathway by the antigen-antibody complex,
leading to formation of the membrane attack complex resulting in cellular injury.
AMR is targetting most often situated on the endothelium resulting in the
histological findings of acute (glomerulitis, peritubular capillaritis) and chronic
(transplant glomerulopathy) vascular injury.

According to Banff 2003 criteria define AMR on three criteria: the

presence of an anti-HLA a Donor-Specific Antibody (DSA) in the serum, tissue
injury with histological evidence (mainly microvascular inflammation or
thrombotic microangiopathy in acute lesions and transplant glomerulopathy in
chronic lesions), and an antibody’s evidence interaction with the vascular
endothelium (moderate microvascular inflammation or C4d-positive staining) in
peritubular capillaries. AMR criteria have been recently revised in Banff 2013
criteria to include recognition of C4d-negative AMR, as the sensitivity to detect
C4d varies greatly depending on the antibody used and the technique.

In this study, all patients aged 18 years and above that had developed
severe AMR following renal transplantation (living or cadaveric donor) conducted
between September 2011 and September 2013. AMR was suspected if there was
acute renal dysfunction (an increase inserum creatinine of >20% from basal level)
or an absence of a decrease inserum creatininein the days after transplantation.

Assassment Technique

1. Standard Operating Procedure of Graft Biopsy

Equipment and Material of Graft Biopsy, such as:

1. Materials and Equipment 6. Liquid nitrogen canister

2. 100% Ethyl Alcohol 7. TELFA Non-adherent
3. Primary collection tray Dressing
4. 15 ml conical vials 8. or Pad
5. Liquid nitrogen storage tank 9. Sterile Forceps
 10. Scalpel 14. Styrofoam Float
11. Aluminum Foil 15. Ruler (suggested to measure
12. Small Airtight bags (for size of biopsy piece)
13. cryomolds)

AMR was confirmed by a graft biopsy, and was diagnosed according to

the Banff 2003 (which was the diagnosis criteria at the moment of treatment) and
reanalyzed using Banff 2013 criteria. Biopsy findings were correlated with DSA
levels performed on sera collected within 24 hours of the biopsy. The included
patients had either a refractory course after standard treatment (steroid pulses, IV-
Ig, plasmapheresis). Patient also had biologic or histologic signs of thrombotic
microangiopathy (TMA) associated with the rejection. Biologic signs of TMA are
the presence of schisocytes in the peripheral blood smear, decrease in platelet
count, high LDL levels and low haptoglobin levels. C4d staining was performed
by immunohistochemistry.
Laboratory Test

Serum samples from transplant patients were collected at the time of

AMR, and analyzed using Luminex assays technology. Specificities of HLA class
I (A and B) and class II (DR and DQ) IgG antibodies were determined with LAB
Screen single-antigen HLA class I(97 beads) and class II (92 beads) detection
tests according to the manufacturer’s instructions. Presence and specificity of
antibodies were then tested using a Lab Scan100, and the mean fluorescence
intensity (MFI) of each sample with each bead was evaluated. A cut off value of
MFI >1000 was considered positive. The presence of C1q-binding DSA also
tested by single antigen flow bead assays according to the manufacturer’s
protocol.

The Purpose of Diagnostic Tests

The Aim of laboratorium test such as screening and analyzed antibodies

that contained in AMR’s patient blood serum. The endpoint was a composite
criterion defined as a positive response to treatment: a functioning graft with no
signs of biological TMA, and stable renal function without dialysis.
Citation

Elias M, Nnang-Obada E, Beaudreuil S, Suberbielle C, Fremeaux-Bacch V, et al.

Complement Inhibition Is Efficient in Early but Not Late Antibody-mediated
Rejection After Kidney Transplantation. Int J Ren Dis Ther. 2018 Jul;1(1):104