How do you distinguish TMA caused by CNI toxicity versus antibody mediated rejection in a kidney transplant patient?

It really boils down to "the company you keep". If the biopsy shows evidence of antibody-mediated rejection with peritubular capillaritis, glomerulitis, or C4d positivity, I would lean towards AMR-associated TMA. Also need to always consider whether the primary cause of the ESKD. Was there an undiag...