Widespread tissue necrosis of the renal parenchyma is evident.

The interstitium shows edema and dissecting hemorrhage as the parenchyma begins to wither away from vascular ischemia.

This vessel shows fibrinoid necrosis (arrow) and is filled with inflammation. There is a transmural lymphocytic infiltrate.

Grade III acute rejection of the kidney is a serious condition not infrequently evolving into graft loss. Histologically, there is transmural arteritis or transmural fibrinoid necrosis associated with parenchymal necrosis and interstitial hemorrhage.