Till the early 1990s there was no standardized international classification of renal allograft biopsies resulting in considerable heterogeneity in reporting among the various centers. A group of dedicated renal pathologists, nephrologists, and transplant surgeons developed a schema in Banff, Canada in 1991. Subsequently there have been updates at regular intervals. The following review presents the evolution of the Banff classification and its utility for clinicians.

This study was aimed at evaluating the clinicopathologic features of plasma cell-rich acute rejection (PCAR) of renal allograft and comparing them with acute cellular rejection (ACR), non-plasma cell-rich type. During a 2-year period, eight renal allograft biopsies were diagnosed as PCAR (plasma cells >10% of interstitial infiltrate). For comparison, 14 biopsies with ACR were included in the study. Detailed pretransplant data, serum creatinine at presentation, and other clinical features of all these cases were noted. Renal biopsy slides were reviewed and relevant immunohistochemistry performed for characterization of plasma cell infiltrate. The age range and duration of transplantation to diagnosis of acute rejection were comparable in both the groups. Histologically, the proportion of interstitial plasma cells, mean interstitial inflammation, and tubulitis score were higher in the PCAR group compared with cases with ACR. A significant difference was found in the outcome at last follow-up, being worse in patients with PCAR. This study shows that PCAR portends a poor outcome compared with ACR, with comparable Banff grade of rejection. Due to its rarity and recent description, nephrologists and renal pathologists need to be aware of this entity.

Background: The kidney normally plays an important role in the metabolism, degradation and excretion of thyroid hormones. Chronic kidney disease (CKD) affects the hypothalamus pituitary thyroid axis and peripheral metabolism of thyroid hormone and thus affects thyroid function in many ways. Despite considerable overlap in the symptoms related to hypothyroidism and advanced chronic kidney disease, relatively little is known about the prevalence of thyroid abnormalities in persons with CKD. In patients with end-stage renal disease, it has been suggested that primary hypothyroidism may be more common in patients with end stage renal disease (ESRD) compared with the general population. Thus this study was conducted to estimate the prevalence of hypothyroid in CKD. Objectives: To study the prevalence of hypothyroid in CKD and to see if prevalence increases with advancement of CKD stage. Materials and methods: This study is a Cross-Sectional study that was conducted among nondialytic CKD patients attending Nephrology OPD of GMCH from March 2014 to Feb 2016. Out of 1742 CKD patients, 280 patients who met the study criteria were included in the study. Demographic features (age and sex) and medical history of each patient were noted at the time of diagnosis. Results: The mean age of patients with overt hypothyroid was 59.64 years, in sub-clinical hypothyroid group was 58.14 years, and in patients with normal thyroid function was 55.51 years. We observed that prevalence of hypothyroidism was increased in patients with reduced GFR, and it increases as estimated glomerular filtration rate (eGFR) decreases ranging from 13.33% in stage 2 to 35.55% in ESRD (end stage renal disease). We also found that 68.8% of hypothyroids have sub-clinical hypothyroidism. Conclusion: This study concludes that prevalence of hypothyroid in CKD is more than that of general population and it further increases as eGFR decreases.

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