Table 2 Interpretation of the Banff Classification
Banff code | Descriptive term | Pathophysiology | Interpretation | Treatment |
|---|---|---|---|---|
i | Interstitial inflammation | Infiltration of interstitium by mononuclear cells | Linked with cellular rejection but also viral infection | Intensification of immunosuppression –often pulsed intravenous steroids |
t | Tubulitis | Infiltration of renal tubules by mononuclear cells | Linked with cellular rejection but also viral infection | Intensification of immunosuppression –often pulsed intravenous steroids |
g | Glomerulitis | Margination of inflammatory leukocytes in the glomerular capillary loops | Marker of humeral rejection | Intensification of immunosuppression if not too much chronic damage |
v | Arterial inflammation | Inflammation of arterial wall with infiltration of mononuclear cells | Marker of either severe cellular rejection or humeral rejection | Intensification of immunosuppression ifnot too much chronic damage |
ptc | Peritubular capillaritis | Margination of inflammatory cells in the peritubular capillaries | Marker of humeral rejection | Intensification of immunosuppression if not too much chronic damage |
ci | Interstitial Fibrosis | Interstitial structure replaced by fibrosis | Marker of chronic damage | Poor prognostic sign – may prompt reduction in CNI |
ct | Tubular atrophy | Interstitial tubules involuted | Marker of chronic damage | Poor prognostic sign – may prompt reduction in CNI |
cg | Transplant glomerulopathy | Interposition of mesangium and thickening of GBM | Associated with proteinuria and development of DSAs – End lesion of CAMR | Poor prognosis – no known treatment but intensification of immunosuppression often practiced |
mm | Mesangial matrix expansion | Increase of thickness of mesangial matrix | Marker of microvascular damage to glomerulus | Usually interpreted in association with other findings |
cv | Arterial fibrointimal thickening | Expansion of intima between endothelium and media | Marker of chronic damage – non-specific | Poor prognostic sign – vascular protective measures |
ah | Arteriolar hyalinosis | Nodular deposition of hyaline | CNI toxicity but non-specific (e.g. HT, DM, lipids) | Reduction or withdrawal of CNI |