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Kotton CN, Kamar N, Wojciechowski D, Eder M, Hopfer H, Randhawa P, Sester M, Comoli P, Tedesco Silva H, Knoll G, Brennan DC, Trofe-Clark J, Pape L, Axelrod D, Kiberd B, Wong G, Hirsch HH. The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation. Transplantation 2024; 108:1834-1866. [PMID: 38605438 PMCID: PMC11335089 DOI: 10.1097/tp.0000000000004976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 04/13/2024]
Abstract
BK polyomavirus (BKPyV) remains a significant challenge after kidney transplantation. International experts reviewed current evidence and updated recommendations according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Risk factors for BKPyV-DNAemia and biopsy-proven BKPyV-nephropathy include recipient older age, male sex, donor BKPyV-viruria, BKPyV-seropositive donor/-seronegative recipient, tacrolimus, acute rejection, and higher steroid exposure. To facilitate early intervention with limited allograft damage, all kidney transplant recipients should be screened monthly for plasma BKPyV-DNAemia loads until month 9, then every 3 mo until 2 y posttransplant (3 y for children). In resource-limited settings, urine cytology screening at similar time points can exclude BKPyV-nephropathy, and testing for plasma BKPyV-DNAemia when decoy cells are detectable. For patients with BKPyV-DNAemia loads persisting >1000 copies/mL, or exceeding 10 000 copies/mL (or equivalent), or with biopsy-proven BKPyV-nephropathy, immunosuppression should be reduced according to predefined steps targeting antiproliferative drugs, calcineurin inhibitors, or both. In adults without graft dysfunction, kidney allograft biopsy is not required unless the immunological risk is high. For children with persisting BKPyV-DNAemia, allograft biopsy may be considered even without graft dysfunction. Allograft biopsies should be interpreted in the context of all clinical and laboratory findings, including plasma BKPyV-DNAemia. Immunohistochemistry is preferred for diagnosing biopsy-proven BKPyV-nephropathy. Routine screening using the proposed strategies is cost-effective, improves clinical outcomes and quality of life. Kidney retransplantation subsequent to BKPyV-nephropathy is feasible in otherwise eligible recipients if BKPyV-DNAemia is undetectable; routine graft nephrectomy is not recommended. Current studies do not support the usage of leflunomide, cidofovir, quinolones, or IVIGs. Patients considered for experimental treatments (antivirals, vaccines, neutralizing antibodies, and adoptive T cells) should be enrolled in clinical trials.
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Affiliation(s)
- Camille N. Kotton
- Transplant and Immunocompromised Host Infectious Diseases Unit, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University Paul Sabatier, Toulouse, France
| | - David Wojciechowski
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Eder
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Helmut Hopfer
- Division of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Parmjeet Randhawa
- Division of Transplantation Pathology, The Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
| | - Patrizia Comoli
- Cell Factory and Pediatric Hematology/Oncology Unit, Department of Mother and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Helio Tedesco Silva
- Division of Nephrology, Hospital do Rim, Fundação Oswaldo Ramos, Paulista School of Medicine, Federal University of São Paulo, Brazil
| | - Greg Knoll
- Department of Medicine (Nephrology), University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Jennifer Trofe-Clark
- Renal-Electrolyte Hypertension Division, Associated Faculty of the Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
- Transplantation Division, Associated Faculty of the Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
| | - Lars Pape
- Pediatrics II, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - David Axelrod
- Kidney, Pancreas, and Living Donor Transplant Programs at University of Iowa, Iowa City, IA
| | - Bryce Kiberd
- Division of Nephrology, Dalhousie University, Halifax, NS, Canada
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Hans H. Hirsch
- Division of Transplantation and Clinical Virology, Department of Biomedicine, Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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Attieh RM, Roach D, Wadei HM, Parikh N, Me HM, Durvasula RV, Oring J. Case Report: Early-Onset Adenovirus Nephritis Without Hemorrhagic Cystitis Following Kidney Transplantation. Transplant Proc 2024; 56:1196-1199. [PMID: 38851958 DOI: 10.1016/j.transproceed.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024]
Abstract
We report a case of adenovirus nephritis (ADVN) in a kidney transplant recipient (KTR) occurring within 8 days post-transplantation. The patient, a 35-year-old male, displayed systemic symptoms, high-grade fever, and acute kidney injury (AKI) without signs of hemorrhagic cystitis (HC). Extensive diagnostic workup revealed widespread necrotizing granulomatous inflammation in the allograft, leading to the identification of adenovirus (ADV) via histopathology and polymerase chain reaction (PCR) testing. The source of ADV transmission remained uncertain, raising questions about the potential donor-derived infection. Unlike typical ADVN cases, the patient exhibited no hematuria or urinary symptoms. The case underscores the atypical presentation of ADVN in KTRs, challenging the conventional understanding of its timeline, transmission routes, and associated clinical features. We discuss the diagnostic challenges, histological findings, and management strategies for ADVN, emphasizing the importance of considering this entity in KTRs with unexplained fever and AKI, even in the absence of classical urinary symptoms or hematuria.
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Affiliation(s)
- Rose Mary Attieh
- Department of Transplant, Division of Kidney and Pancreas Transplant, Mayo Clinic, Jacksonville, Florida; Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Dawn Roach
- Department of Infectious Disease, Mayo Clinic, Jacksonville, Florida
| | - Hani M Wadei
- Department of Transplant, Division of Kidney and Pancreas Transplant, Mayo Clinic, Jacksonville, Florida
| | - Namrata Parikh
- Department of Transplant, Division of Kidney and Pancreas Transplant, Mayo Clinic, Jacksonville, Florida
| | - Hay Me Me
- Department of Transplant, Division of Kidney and Pancreas Transplant, Mayo Clinic, Phoenix, Arizona
| | | | - Justin Oring
- Department of Infectious Disease, Mayo Clinic, Jacksonville, Florida.
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3
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Jagannathan G, Weins A, Daniel E, Crew RJ, Swanson SJ, Markowitz GS, D'Agati VD, Andeen NK, Rennke HG, Batal I. The pathologic spectrum of adenovirus nephritis in the kidney allograft. Kidney Int 2023; 103:378-390. [PMID: 36436678 DOI: 10.1016/j.kint.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/16/2022] [Accepted: 10/28/2022] [Indexed: 11/25/2022]
Abstract
Adenovirus nephritis (ADVN) is a rare and understudied complication of kidney transplantation. Unlike BK virus nephropathy (BKVN), our knowledge of clinicopathologic manifestations of ADVN remains rudimentary and essentially limited to case reports. To expand on this, we retrospectively studied 11 kidney transplant recipients with ADVN and compared their allograft biopsies to 33 kidney transplant recipients with BKVN using conventional microscopy and the 770 gene Nanostring Banff Human Organ Transplant Profiling Panel. Patients with ADVN had a median age of 44 years, were predominantly male, and developed ADVN at a median of 31 months post-transplantation. Eight patients presented with fever and ten had hematuria. The most common histologic manifestations included granulomas (82%), tubulocentric inflammation (73%), and tubular degenerative changes consistent with acute tubular necrosis (73%). During a median follow-up of 55 months after biopsy, three patients developed allograft failure from subsequent acute rejection. All seven patients with available follow-up PCR showed resolution of viremia at a median of 30 days after diagnosis. Compared to BKVN, ADVN demonstrated more granulomas and less tubulointerstitial scarring. On follow-up, patients with ADVN had more rapid clearance of viral DNA from plasma. Transcriptomic analyses showed that ADVN had increased expression of several pro-inflammatory transcriptomes, mainly related to innate immunity, was associated with increased expression of transcripts with inhibitory effects on inflammatory response and showed higher enrichment with neutrophils, which can cause aggressive but short-lasting damage. Thus, we demonstrate that, despite its association with aggressive neutrophil-rich inflammation, ADVN does not often lead to allograft failure. Hence, preventing subsequent acute rejection following resolution of ADVN may improve allograft survival.
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Affiliation(s)
- Geetha Jagannathan
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Astrid Weins
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Daniel
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Russel J Crew
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Sidney J Swanson
- Department of Surgery, Christiana Hospital, Newark, Delaware, USA
| | - Glen S Markowitz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Vivette D D'Agati
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicole K Andeen
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ibrahim Batal
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA.
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Luciani LG, Mattevi D. Urinary Tract Infections: Virus. ENCYCLOPEDIA OF INFECTION AND IMMUNITY 2022. [PMCID: PMC8357242 DOI: 10.1016/b978-0-12-818731-9.00139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Although viruses are common in the urinary tract in healthy people, viral infections can become a major concern in immunocompromised individuals. Patients undergoing hematopoietic stem cell or solid organ transplantation may be particularly susceptible to BK and other viruses, and experience a high risk of mortality. The most common presentation in this setting is hemorrhagic cystitis. The treatment is mostly supportive, including the reduction of immunosuppression; a variety of experimental agents has also been proposed. A different context is offered by chronic (HBV, HCV, HIV) or acute/subacute (Dengue, Hantavirus, etc.) infections, where the kidneys can be secondarily involved and suffer from several glomerular syndromes. Many protocols based on different oral direct-acting antivirals and combined antiretrovirals are available, according to the systemic infection. Viral infections can be classified according to the organ involved, i.e. lower (bladder) or upper urinary tract (kidneys, ureters), and to the mechanism of injury. A section is dedicated to the current breakout of SARS-CoV-2, which does not spare the urinary tract, sometimes with serious implications. Even if this topic is mostly the discipline of ultra-dedicated physicians, this overview has a practical approach and could be useful to a wider medical audience, especially in times of viral pandemics.
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Lynch JP, Kajon AE. Adenovirus: Epidemiology, Global Spread of Novel Types, and Approach to Treatment. Semin Respir Crit Care Med 2021; 42:800-821. [PMID: 34918322 DOI: 10.1055/s-0041-1733802] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Adenoviruses (AdVs) are DNA viruses that typically cause mild infections involving the upper or lower respiratory tract, gastrointestinal tract, or conjunctiva. Rare manifestations of AdV infections include hemorrhagic cystitis, hepatitis, hemorrhagic colitis, pancreatitis, nephritis, or meningoencephalitis. AdV infections are more common in young children, due to lack of humoral immunity. Epidemics of AdV infection may occur in healthy children or adults in closed or crowded settings (particularly military recruits). The vast majority of cases are self-limited. However, the clinical spectrum is broad and fatalities may occur. Dissemination is more likely in patients with impaired immunity (e.g., organ transplant recipients, human immunodeficiency virus infection). Fatality rates for untreated severe AdV pneumonia or disseminated disease may exceed 50%. More than 100 genotypes and 52 serotypes of AdV have been identified and classified into seven species designated HAdV-A through -G. Different types display different tissue tropisms that correlate with clinical manifestations of infection. The predominant types circulating at a given time differ among countries or regions, and change over time. Transmission of novel strains between countries or across continents and replacement of dominant viruses by new strains may occur. Treatment of AdV infections is controversial, as prospective, randomized therapeutic trials have not been done. Cidofovir has been the drug of choice for severe AdV infections, but not all patients require treatment. Live oral vaccines are highly efficacious in reducing the risk of respiratory AdV infection and are in routine use in the military in the United States but currently are not available to civilians.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Adriana E Kajon
- Infectious Disease Program, Lovelace Biomedical Research Institute, Albuquerque, New Mexico
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Yahr J, Hassanein M, Herlitz L, Fatica R. Granulomatous Tubulointerstitial Nephritis in a Kidney Transplant Recipient: Case Report and Review of the Literature. Transplant Proc 2021; 53:2546-2551. [PMID: 34489112 DOI: 10.1016/j.transproceed.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/03/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Granulomatous tubulointerstitial nephritis (GTIN) is a rare pathologic finding on kidney biopsy. GTIN can be associated with drugs, infection, systemic granulomatous disease, and tubulointerstitial nephritis with uveitis syndrome. We present a case of GTIN in a kidney transplant recipient (KTR) and a literature review of published cases of GTIN in KTRs. CASE PRESENTATION A 65-year-old man with a history of pulmonary and ocular tuberculosis (TB), who had undergone deceased donor kidney transplant 8 years prior, was admitted for acute kidney injury, hypercalcemia, and uveitis. His medications included rifabutin, isoniazid, and tacrolimus. Serum laboratory tests revealed creatinine of 2.65 mg/dL (baseline 1.1-1.5 mg/dL) and corrected calcium of 13.2 mg/dL. Hypercalcemia workup showed parathyroid hormone 7 pg/mL, 1,25(OH) vitamin D 54 pg/mL, parathyroid hormone-related peptide <2.0 pmol/L, and angiotensin-converting enzyme 47 U/L. Kidney biopsy showed GTIN with noncaseating granulomas. Universal polymerase chain reaction testing for acid-fast bacilli, fungus, and bacteria was negative. He was treated with prednisone, and his kidney function returned to baseline, and his hypercalcemia resolved. DISCUSSION GTIN is a rare entity seen in less than 1% of transplanted kidney biopsies. The exactly etiology of this GTIN case remains unknown. TB could not be entirely ruled out, because the patient was receiving active anti-TB therapy. Our literature review showed infection to be the leading cause of GTIN in KTRs and that GTIN with concomitant uveitis remains exceedingly rare. Steroids may be useful in certain cases.
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Affiliation(s)
- Jordana Yahr
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mohamed Hassanein
- Department of Nephrology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Leal Herlitz
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Richard Fatica
- Department of Nephrology, Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
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Suárez Fernández ML, Ridao Cano N, Álvarez Santamarta L, Gago Fraile M, Blake O, Díaz Corte C. A Current Review of the Etiology, Clinical Features, and Diagnosis of Urinary Tract Infection in Renal Transplant Patients. Diagnostics (Basel) 2021; 11:1456. [PMID: 34441390 PMCID: PMC8392421 DOI: 10.3390/diagnostics11081456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022] Open
Abstract
Urinary tract infection (UTI) represents the most common infection after kidney transplantation and remains a major cause of morbidity and mortality in kidney transplant (KT) recipients, with a potential impact on graft survival. UTIs after KT are usually caused by Gram-negative microorganisms. Other pathogens which are uncommon in the general population should be considered in KT patients, especially BK virus since an early diagnosis is necessary to improve the prognosis. UTIs following kidney transplantation are classified into acute simple cystitis, acute pyelonephritis/complicated UTI, and recurrent UTI, due to their different clinical presentation, prognosis, and management. Asymptomatic bacteriuria (ASB) represents a frequent finding after kidney transplantation, but ASB is considered to be a separate entity apart from UTI since it is not necessarily a disease state. In fact, current guidelines do not recommend routine screening and treatment of ASB in KT patients, since a beneficial effect has not been shown. Harmful effects such as the development of multidrug-resistant (MDR) bacteria and a higher incidence of Clostridium difficile diarrhea have been associated with the antibiotic treatment of ASB.
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Affiliation(s)
- María Luisa Suárez Fernández
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | - Natalia Ridao Cano
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | - Lucia Álvarez Santamarta
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | - María Gago Fraile
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | | | - Carmen Díaz Corte
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
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Thorne P, Arroyo JP, Concepcion BP. Fever and Gross Hematuria in a Kidney Transplant Recipient. KIDNEY360 2020; 1:712-713. [PMID: 35372939 PMCID: PMC8815547 DOI: 10.34067/kid.0000732020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Peter Thorne
- Vanderbilt University Medical Center, Nashville, Tennessee
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Approach to infection and disease due to adenoviruses in solid organ transplantation. Curr Opin Infect Dis 2020; 32:300-306. [PMID: 31116132 DOI: 10.1097/qco.0000000000000558] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Adenoviruses are an important cause of morbidity and mortality of solid organ transplant patients and remain a clinical challenge with regard to diagnosis and treatment. In this review, we provide an approach to identification and classification of adenovirus infection and disease, highlight risk factors, and outline management options for adenovirus disease in solid organ transplant patients. RECENT FINDINGS Additional clinical data and pathologic findings of adenovirus disease in different organs and transplant recipients are known. Unlike hematopoietic cell transplant recipients, adenovirus blood PCR surveillance and preemptive therapy is not supported in solid organ transplantation. Strategies for management of adenovirus disease continue to evolve with newer antivirals, such as brincidofovir and adjunctive immunotherapies, but more studies are needed to support their use. SUMMARY Distinguishing between adenovirus infection and disease is an important aspect in adenovirus management as treatment is warranted only in symptomatic solid organ transplant patients. Supportive care and decreasing immunosuppression remain the mainstays of management. Cidofovir remains the antiviral of choice for severe or disseminated disease. Given its significant nephrotoxic effect, administration of probenecid and isotonic saline precidofovir and postcidofovir infusion is recommended.
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Gu J, Su QQ, Zuo TT, Chen YB. Adenovirus diseases: a systematic review and meta-analysis of 228 case reports. Infection 2020; 49:1-13. [PMID: 32720128 DOI: 10.1007/s15010-020-01484-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/19/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The clinical characteristics of various adenovirus (ADV) infection are underexplored up till now. To investigate the risk factors, manifestation, current status of ADV species, treatment and prognosis of this disease. METHODS We performed a Pubmed and Embase systematic review for case report reporting the ADV infection to analyze the clinical characteristics of disease. RESULTS Initial database searched identified articles of which 168 (228 cases) were included in the final analysis. Previous solid organ transplantation [odds ratio (OR) = 3.45, 95% CI 1.31-9.08, P = 0.01], hematopoietic stem cell transplant (OR = 4.24, 95% CI 1.33-13.51, P = 0.01) and hematological malignancy (OR = 4.78, 95% CI 1.70-13.46, P = 0.01) were associated with increased risk of disseminated ADV infection. Use of corticosteroids (OR = 3.86, 95% CI 1.21-12.24, P = 0.02) was a significant risk factor for acquiring urinary tract infections. A total of six species (21 types) of ADV infection have been identified in 100/228 (43.9%) cases. ADV B was the most common species. ADV B species (26/60, 52.0% or 5/41, 12.2% P = 0.001) were more isolated in patients with ADV pneumonia. ADV C (13/15, 86.7% versus 35/86, 40.7% P = 0.001) species were more identified in patients with disseminated disease. The species associated with keratoconjunctivitis is only ADV D in our analysis. Urinary tract ADV infections were observed in ADV A/B/D species. Cidofovir (CDV) (82/228, 36.0%) remained the most commonly antiviral therapy in our cases, followed by ribavirin (15/228, 6.6%), ganciclovir (18/228, 7.9%), and brincidofovir (12/228, 5.3%). Brincidofovir was administered as salvage therapy in 10 cases. Death was reported in 81/228 (35.5%) patients. Mortality rate was higher among patients with gastrointestinal (GI) ADV infection (5/10, 50.0%), ADV pneumonia (20/45, 44.4%) and disseminated ADV infection (53/122, 43.4%). CONCLUSION Previous solid organ transplantation, hematopoietic stem cell transplant and hematological malignancy were risk factors for disseminated ADV infection. Use of corticosteroids was significant for urinary tract ADV infection. Different species correlated with different clinical manifestations of infection. Mortality rate was higher among patients with GI disease, pneumonia and disseminated disease. Our review clarified the current treatment of ADV infections, and more treatment required further investigation.
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Affiliation(s)
- Jie Gu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China
| | - Qing-Qing Su
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China
| | - Ting-Ting Zuo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China
| | - Yan-Bin Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China.
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12
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Joyce E, Glasner P, Ranganathan S, Swiatecka-Urban A. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring. Pediatr Nephrol 2017; 32:577-587. [PMID: 27155873 PMCID: PMC5099107 DOI: 10.1007/s00467-016-3394-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/15/2016] [Accepted: 04/04/2016] [Indexed: 12/15/2022]
Abstract
Tubulointerstitial nephritis (TIN) is a frequent cause of acute kidney injury (AKI) that can lead to chronic kidney disease (CKD). TIN is associated with an immune-mediated infiltration of the kidney interstitium by inflammatory cells, which may progress to fibrosis. Patients often present with nonspecific symptoms, which can lead to delayed diagnosis and treatment of the disease. Etiology can be drug-induced, infectious, idiopathic, genetic, or related to a systemic inflammatory condition such as tubulointerstitial nephritis and uveitis (TINU) syndrome, inflammatory bowel disease, or immunoglobulin G4 (IgG4)-associated immune complex multiorgan autoimmune disease (MAD). It is imperative to have a high clinical suspicion for TIN in order to remove potential offending agents and treat any associated systemic diseases. Treatment is ultimately dependent on underlying etiology. While there are no randomized controlled clinical trials to assess treatment choice and efficacy in TIN, corticosteroids have been a mainstay of therapy, and recent studies have suggested a possible role for mycophenolate mofetil. Urinary biomarkers such as alpha1- and beta2-microglobulin may help diagnose and monitor disease activity in TIN. Screening for TIN should be implemented in children with inflammatory bowel disease, uveitis, or IgG4-associated MAD.
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Affiliation(s)
- Emily Joyce
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
| | - Paulina Glasner
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk and Department of Ophthalmology, Medical University of Gdansk, 80-299, Gdańsk, Poland
| | - Sarangarajan Ranganathan
- Department of Pediatric Pathology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Agnieszka Swiatecka-Urban
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
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Farris AB, Ellis CL, Rogers TE, Chon WJ, Chang A, Meehan SM. Renal allograft granulomatous interstitial nephritis: observations of an uncommon injury pattern in 22 transplant recipients. Clin Kidney J 2017; 10:240-248. [PMID: 28396741 PMCID: PMC5381240 DOI: 10.1093/ckj/sfw117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/04/2016] [Indexed: 01/06/2023] Open
Abstract
Background: Granulomatous interstitial nephritis (GIN) is uncommon in native kidneys, and descriptions in allografts are few. We report clinical and pathologic findings in 22 allograft recipients with GIN identified in renal allograft biopsies and nephrectomies. Methods: Renal allografts with GIN were retrieved from the pathology files of two academic medical centers. Available clinical and pathologic data were compiled retrospectively for a 23-year period. Results: GIN was present in 23 specimens from 22 patients (15 males and 7 females) with allograft dysfunction [serum creatinine averaged 3.3 mg/dL (range 1.4–7.8)], at a mean age of 48 years (range 22–77). GIN was identified in 0.3% of biopsies at a mean of 552 days post transplantation (range 10–5898). GIN was due to viral (5), bacterial (5) and fungal (2) infections in 12 (54.5%), and drug exposure was the likely cause in 5 cases (22.7%). One had recurrent granulomatosis with polyangiitis. In 4 cases, no firm etiology of GIN was established. Of 18 patients with follow up data, 33.3% had a complete response to therapy, 44.5% had a partial response and 22.2% developed graft loss due to fungal and E. coli infections. All responders had graft survival for more than 1 year after diagnosis of GIN. Conclusions: Allograft GIN is associated with a spectrum of etiologic agents and was identified in 0.3% of biopsies. Graft failure occurred in 22% of this series, due to fungal and bacterial GIN; however, most had complete or partial dysfunction reversal and long–term graft survival after appropriate therapy.
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Affiliation(s)
| | | | | | | | | | - Shane M Meehan
- University of Chicago, Chicago, IL USA; Sharp Memorial Hospital, San Diego, CA, USA
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14
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Nanmoku K, Ishikawa N, Kurosawa A, Shimizu T, Kimura T, Miki A, Sakuma Y, Yagisawa T. Clinical characteristics and outcomes of adenovirus infection of the urinary tract after renal transplantation. Transpl Infect Dis 2017; 18:234-9. [PMID: 26919131 DOI: 10.1111/tid.12519] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/28/2015] [Accepted: 01/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urinary tract infection caused by human adenovirus (HAdV) after renal transplantation (RT) results in graft loss because of concomitant nephropathy and acute rejection and may result in death because of systemic dissemination. METHODS We assessed the time period between RT and disease onset, symptoms, treatment details, disease duration, renal graft function, outcomes, and complications. RESULTS HAdV infection of the urinary tract occurred in 8 of 170 renal transplant recipients. Symptoms were macrohematuria in all 8 patients, dysuria in 7, and fever in 5. The median period from RT to disease onset was 367 (range, 7-1763) days, and the median disease duration was 15 (range, 8-42) days. The mean serum creatinine (sCr) level prior to onset was 1.35 ± 0.48 mg/dL and the mean maximum sCr level during disease was 2.34 ± 1.95 mg/dL. These values were increased by ≥25% in 5 patients. The mean sCr levels when symptoms resolved was 1.54 ± 0.67 mg/dL, and no significant difference was seen before, during, or after disease onset (P = 0.069). Two patients were diagnosed with HAdV viremia and 1 with acute tubulointerstitial nephritis revealed on biopsy. In addition to a reduction in immunosuppressant dosage, 2 patients received gammaglobulins and 5 received ganciclovir. CONCLUSION Symptoms of all patients were alleviated, although some patients developed nephritis or viremia. Hence, the possibility of exacerbation should always be considered. Adequate follow-up observation should be conducted, and diligent and aggressive therapeutic intervention is required to prevent the condition from worsening.
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Affiliation(s)
- K Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - N Ishikawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - A Kurosawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kimura
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - A Miki
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Y Sakuma
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
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15
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Hemmersbach-Miller M, Duronville J, Sethi S, Miller SE, Howell DN, Henshaw N, Alexander BD, Roberts JK. Hemorrhagic Herpes Simplex Virus Type 1 Nephritis: An Unusual Cause of Acute Allograft Dysfunction. Am J Transplant 2017; 17:287-291. [PMID: 27545820 DOI: 10.1111/ajt.14022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 01/25/2023]
Abstract
Interstitial nephritis due to viruses is well-described after solid organ transplantation. Viruses implicated include cytomegalovirus; BK polyomavirus; Epstein-Barr virus; and, less commonly, adenovirus. We describe a rare case of hemorrhagic allograft nephritis due to herpes simplex virus type 1 at 10 days after living donor kidney transplantation. The patient had a favorable outcome with intravenous acyclovir and reduction of immunosuppression.
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Affiliation(s)
- M Hemmersbach-Miller
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC
| | - J Duronville
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - S Sethi
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - S E Miller
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - D N Howell
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - N Henshaw
- Clinical Microbiology Laboratory, Duke University Medical Center, Durham, NC
| | - B D Alexander
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC
| | - J K Roberts
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC
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16
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Seralathan G, Kurien AA. Adenovirus Interstitial Nephritis: An Unusual Cause for Early Graft Dysfunction. Indian J Nephrol 2017; 28:385-388. [PMID: 30271002 PMCID: PMC6146728 DOI: 10.4103/ijn.ijn_218_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We describe a rare case of adenovirus interstitial nephritis in a 37-year-old man, 4 weeks following deceased donor renal transplantation. He presented with gross hematuria and acute graft dysfunction. A renal biopsy revealed necrotizing tubulointerstitial nephritis with intranuclear viral inclusions in the tubular epithelial cells. Immunohistochemistry and polymerase chain reaction confirmed adenovirus infection. Reduction in immunosuppression alone resulted in rapid improvement of graft function. Awareness of the clinical and characteristic biopsy findings may help establish the correct diagnosis, which is crucial as disseminated infection, if left untreated, is associated with a high mortality rate in renal allograft recipients.
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Affiliation(s)
- G Seralathan
- Department of Nephrology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - A A Kurien
- Center for Renal and Urological Pathology Private Limited, Chennai, Tamil Nadu, India
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17
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Lynch JP, Kajon AE. Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention. Semin Respir Crit Care Med 2016; 37:586-602. [PMID: 27486739 PMCID: PMC7171713 DOI: 10.1055/s-0036-1584923] [Citation(s) in RCA: 321] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Adenoviruses (AdVs) are DNA viruses that typically cause mild infections involving the upper or lower respiratory tract, gastrointestinal tract, or conjunctiva. Rare manifestations of AdV infections include hemorrhagic cystitis, hepatitis, hemorrhagic colitis, pancreatitis, nephritis, or meningoencephalitis. AdV infections are more common in young children, due to lack of humoral immunity. Epidemics of AdV infection may occur in healthy children or adults in closed or crowded settings (particularly military recruits). The disease is more severe and dissemination is more likely in patients with impaired immunity (e.g., organ transplant recipients, human immunodeficiency virus infection). Fatality rates for untreated severe AdV pneumonia or disseminated disease may exceed 50%. More than 50 serotypes of AdV have been identified. Different serotypes display different tissue tropisms that correlate with clinical manifestations of infection. The predominant serotypes circulating at a given time differ among countries or regions, and change over time. Transmission of novel strains between countries or across continents and replacement of dominant viruses by new strains may occur. Treatment of AdV infections is controversial, as prospective, randomized therapeutic trials have not been conducted. Cidofovir is the drug of choice for severe AdV infections, but not all patients require treatment. Live oral vaccines are highly efficacious in reducing the risk of respiratory AdV infection and are in routine use in the military in the United States, but currently are not available to civilians.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Adriana E Kajon
- Department of Infectious Disease, Lovelace Respiratory Research Institute, Albuquerque, New Mexico
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18
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Klein J, Kuperman M, Haley C, Barri Y, Chandrakantan A, Fischbach B, Melton L, Rice K, Saim M, Yango A, Klintmalm G, Rajagopal A. Late presentation of adenovirus-induced hemorrhagic cystitis and ureteral obstruction in a kidney-pancreas transplant recipient. Proc AMIA Symp 2015; 28:488-91. [PMID: 26424950 DOI: 10.1080/08998280.2015.11929318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We report a late presentation of adenovirus-induced renal allograft and bladder infection causing azotemia and hemorrhagic cystitis in a patient 5 years after simultaneous kidney-pancreas transplantation. Adenovirus has been increasingly recognized as a cause of morbidity and mortality in both solid organ and stem cell transplant recipients. We wish to emphasize the importance of early detection, as treatment options involve reduction of immunosuppression, followed by the addition of antiviral agents and supportive care.
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Affiliation(s)
- Jeffrey Klein
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Michael Kuperman
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Clinton Haley
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Yousri Barri
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Arun Chandrakantan
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Bernard Fischbach
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Larry Melton
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Kim Rice
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Muhammad Saim
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Angelito Yango
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Goran Klintmalm
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Arthi Rajagopal
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
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19
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Mehta V, Chou PC, Picken MM. Adenovirus disease in six small bowel, kidney and heart transplant recipients; pathology and clinical outcome. Virchows Arch 2015; 467:603-8. [PMID: 26377431 DOI: 10.1007/s00428-015-1846-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/15/2015] [Accepted: 09/04/2015] [Indexed: 12/15/2022]
Abstract
Adenoviruses are emerging as important viral pathogens in hematopoietic stem cell and solid organ transplant recipients, impacting morbidity, graft survival, and even mortality. The risk seems to be highest in allogeneic hematopoietic stem cell transplant recipients as well as heart, lung, and small bowel transplant recipients. Most of the adenovirus diseases develop in the first 6 months after transplantation, particularly in pediatric patients. Among abdominal organ recipients, small bowel grafts are most frequently affected, presumably due to the presence of a virus reservoir in the mucosa-associated lymphoid tissue. Management of these infections may be difficult and includes the reduction of immunosuppression, whenever possible, combined with antiviral therapy, if necessary. Therefore, an awareness of the pathology associated with such infections is important in order to allow early detection and specific treatment. We reviewed six transplant recipients (small bowel, kidney, and heart) with adenovirus graft involvement from two institutions. We sought to compare the diagnostic morphology and the clinical and laboratory findings. The histopathologic features of an adenovirus infection of the renal graft and one native kidney in a heart transplant recipient included a vaguely granulomatous mixed inflammatory infiltrate associated with rare cells showing a cytopathic effect (smudgy nuclei). A lymphocytic infiltrate, simulating T cell rejection, with admixture of eosinophils was also seen. In the small bowel grafts, there was a focal mixed inflammatory infiltrate with associated necrosis in addition to cytopathic effects. In the heart, allograft adenovirus infection was silent with no evidence of inflammatory changes. Immunohistochemical stain for adenovirus was positive in all grafts and in one native kidney. All patients were subsequently cleared of adenovirus infection, as evidenced by follow-up biopsies, with no loss of the grafts. Adenovirus infection can involve allografts as well as native organs in solid organ transplant recipients. Infection is associated with variable necrosis and acute inflammation, in addition to a rejection-like infiltrate. Hematuria in non-renal solid organ transplant recipients may be associated with adenovirus nephritis and clinically silent graft involvement. Prompt diagnosis (aided by immunohistochemistry (IHC) and serology), with specific treatment, can prevent graft loss.
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Affiliation(s)
- Vikas Mehta
- Pathology, Loyola University Medical Center, Chicago, IL, USA
| | - Pauline C Chou
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Maria M Picken
- Pathology, Loyola University Medical Center, Chicago, IL, USA.
- Department of Pathology, Renal and Transplant Pathology, Loyola University Medical Center, Bldg#l10, Room#2242, 2160 S. First Avenue, Maywood, IL, 60153, USA.
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20
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Ackoundou-N'Guessan C, Coulibaly N, Guei CM, Aye D, N'guessan FY, N'Dah JK, Lagou DA, Tia MW, Coulibaly PA, Nzoue S, Konan S, Gnionsahe DA. [Hemorrhagic cystitis due to adenovirus in a renal transplant recipient: the first reported case in black Africa in a setting of a very beginning of a kidney transplantation program and review of the literature]. Nephrol Ther 2015; 11:104-10. [PMID: 25684056 DOI: 10.1016/j.nephro.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
Viral infections are an important complication of transplantation. Polyomavirus are the commonest viruses that infect the renal allograft. Herpes virus nephropathy has also been described. In the past 15 years, adenovirus nephritis has emerged as a potentially life-threatening disease in renal transplant patients in developed countries. Most of the papers devoted to adenovirus nephritis are reported cases. The fate of such patients in resources-limited countries is not known. Herein, we describe the clinical, biological and prognostic findings of a black African transplanted patient with adenoviral hemorrhagic cystitis. This case is the very first of its kind reported in black Africa in a setting of a start of a renal transplantation pilot project. The patient is a 54-year-old man admitted at the nephrology service for gross haematuria and fever occurred 1 month after kidney transplantation. The diagnosis of adenoviral hemorrhagic cystitis has been suspected because the patient has displayed recurrent conjunctivitis and gastroenteritis well before transplantation, which was then confirmed by the real-time polymerase chain reaction performed on the blood. Conservatory measures associated with immunosuppression reduction have permitted the discontinuation of haematuria. This case has been discussed in regard of the epidemiology, the diagnosis, the treatment, the evolution and the prognosis of the adenoviral infection in the renal transplant patient. A review of the literature has been performed subsequently.
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Affiliation(s)
| | - Noël Coulibaly
- Unité pilote de transplantation rénale, service d'urologie, institut de cardiologie, CHU de Treichville, Km 1 boulevard de Marseille, BP V 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Cyr Monley Guei
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Denis Aye
- Service d'anesthésie et de réanimation, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Francis Yapi N'guessan
- Service d'anesthésie et de réanimation, CHU de Cocody, université Félix Houphouët-Boigny, Abidjan, Cocody, BP V 32 Abidjan, Abidjan, Côte d'Ivoire
| | - Justin Kouame N'Dah
- Service d'anatomie pathologique, CHU de Cocody, université Félix Houphouët-Boigny, Abidjan, Cocody, BP V 32 Abidjan, Abidjan, Côte d'Ivoire
| | | | - Mélanie Weu Tia
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | | | - Sita Nzoue
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Serges Konan
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
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21
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Rady K, Walters G, Brown M, Talaulikar G. Allograft adenovirus nephritis. Clin Kidney J 2014; 7:289-92. [PMID: 25852891 PMCID: PMC4377743 DOI: 10.1093/ckj/sfu020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 02/19/2014] [Indexed: 11/13/2022] Open
Abstract
We present an uncommon case of allograft adenovirus tubulointerstitial nephritis in a 63-year-old male 6 weeks following cadaveric renal transplantation for end-stage renal failure secondary to hypertensive nephrosclerosis. The patient presented with acute onset of fevers, dysuria, haematuria and diarrhoea with acute graft dysfunction. A renal biopsy demonstrated necrotizing tubulointerstitial nephritis with viral cytopathic changes and no evidence of rejection. Adenovirus was identified as the pathogen. Treatment involved the reduction in the patient's usual immunosuppression, intravenous immunoglobulin, piperacillin-tazobactam and ganciclovir. We present the clinical and pathological findings of necrotizing adenoviral nephropathy, highlighting the importance of considering this diagnosis in renal transplant recipients presenting with interstitial nephritis in the setting of a systemic illness.
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Affiliation(s)
- Kirsty Rady
- Department of Nephrology , The Canberra Hospital , Canberra, ACT , Australia
| | - Giles Walters
- Department of Nephrology , The Canberra Hospital , Canberra, ACT , Australia
| | - Michael Brown
- Department of Pathology , The Canberra Hospital , Canberra, ACT , Australia
| | - Girish Talaulikar
- Department of Nephrology , The Canberra Hospital , Canberra, ACT , Australia
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22
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Dawood US, Nelson A, Wu D, Otto S, Russ GR. Disseminated adenovirus infection in kidney transplant recipient. Nephrology (Carlton) 2014; 19 Suppl 1:10-3. [DOI: 10.1111/nep.12192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Ubaidullah S Dawood
- Royal Adelaide Hospital; Adelaide South Australia Australia
- Central and Northern Adelaide Renal and Transplantation Services; Adelaide South Australia Australia
| | - Adam Nelson
- Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Danielle Wu
- Royal Adelaide Hospital; Adelaide South Australia Australia
- Central and Northern Adelaide Renal and Transplantation Services; Adelaide South Australia Australia
| | - Sophia Otto
- Royal Adelaide Hospital; Adelaide South Australia Australia
- SA Pathology; Adelaide South Australia Australia
| | - Graeme R Russ
- Royal Adelaide Hospital; Adelaide South Australia Australia
- Central and Northern Adelaide Renal and Transplantation Services; Adelaide South Australia Australia
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23
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Severe necrotizing adenovirus tubulointerstitial nephritis in a kidney transplant recipient. Case Rep Transplant 2013; 2013:969186. [PMID: 24066254 PMCID: PMC3771480 DOI: 10.1155/2013/969186] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/08/2013] [Indexed: 11/17/2022] Open
Abstract
Adenoviruses (AdV) are emerging pathogens with a prevalence of 11% viruria and 6.5% viremia in kidney transplant recipients. Although AdV infection is common, interstitial nephritis (ADVIN) is rare with only 13 biopsy proven cases reported in the literature. We report a case of severe ADVIN with characteristic histological features that includes severe necrotizing granulomatous lesion with widespread tubular basement membrane rupture and hyperchromatic smudgy intranuclear inclusions in the tubular epithelial cells. The patient was asymptomatic at presentation, and the high AdV viral load (quantitative PCR>2,000,000 copies/mL in the urine and 646,642 copies/mL in the serum) confirmed the diagnosis. The patient showed excellent response to a combination of immunosuppression reduction, intravenous cidofovir, and immunoglobulin therapy resulting in complete resolution of infection and recovery of allograft function. Awareness of characteristic biopsy findings may help to clinch the diagnosis early which is essential since the disseminated infection is associated with high mortality of 18% in kidney transplant recipients. Cidofovir is considered the agent of choice for AdV infection in immunocompromised despite lack of randomized trials, and the addition of intravenous immunoglobulin may aid in resolution of infection while help prevention of rejection.
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24
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Florescu MC, Miles CD, Florescu DF. What do we know about adenovirus in renal transplantation? Nephrol Dial Transplant 2013; 28:2003-10. [PMID: 23493328 DOI: 10.1093/ndt/gft036] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Adenoviruses are common pathogens that have the potential to cause opportunistic infections with significant morbidity and mortality in immunocompromised hosts. The significance of adenoviral infection and disease is incompletely known in the setting of kidney transplantation. Reported adenovirus infections in renal transplant recipients have typically manifested as hemorrhagic cystitis and tubulointerstitial nephritis, less severe diseases than often seen in other solid organ transplant recipients (i.e. pneumonia, hepatitis and enteritis). The prevalent adenovirus subgroups associated with cystitis and nephritis are B1 and B2 with the serotypes 7, 11, 34, 35. However, disseminated or severe adenovirus infections, including fatal cases, have been described in renal transplant recipients. There is uncertainty regarding monitoring of and treatment of this virus. Although not supported by randomized clinical trials, cidofovir is used for the treatment of adenovirus disease not responding to reduction of immunosuppression.
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Affiliation(s)
- Marius C Florescu
- Nephrology Division, University of Nebraska Medical Center, Omaha, NE, USA
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25
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Fever, haematuria, and acute graft dysfunction in renal transplant recipients secondary to adenovirus infection: two case reports. Case Rep Nephrol 2013; 2013:195753. [PMID: 24558620 PMCID: PMC3914224 DOI: 10.1155/2013/195753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 12/28/2012] [Indexed: 11/17/2022] Open
Abstract
We report two cases of adenoviral infection in kidney transplant recipients that presented with different clinical characteristics under similar demographic and posttransplant conditions. The first case presented with fever, gross haematuria, and acute graft dysfunction 15 days following renal transplantation. A graft biopsy, analyzed with immunohistochemistry, yielded negative results. However, the diagnosis was confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. The immunosuppression dose was reduced, and ribavirin treatment was started, for which the patient quickly developed toxicity. Antiviral treatment allowed for transient response; however, a relapse occurred. The viral real-time PCR became negative upon immunosuppression reduction and administration of IVIG; graft function normalized. In the second case, the patient presented with fever and dysuria 1 month after transplantation. The initial imaging studies revealed graft enlargement and areas of hypoperfusion. In this case, the diagnosis was also confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. Adenoviral nephritis was confirmed through a graft biopsy analyzed with light microscopy, immunohistochemistry, and PCR in frozen tissue. The immunosuppression dose was reduced, and IVIG was administered obtaining excellent clinical results along with a negative real-time PCR.
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26
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Hotta K, Fukasawa Y, Sasaki H, Seki T, Togashi M, Harada H. Granulomatous tubulointerstitial nephritis in a renal allograft: three cases report and review of literature. Clin Transplant 2012; 26 Suppl 24:70-5. [PMID: 22747480 DOI: 10.1111/j.1399-0012.2012.01643.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Granulomatous interstitial nephritis (GIN) is a rare histologic diagnosis in renal allografts. We report three cases with GIN. Case 1: a 37-yr-old woman received a kidney from her mother. On follow-up 15 months later, serum creatinine was increased and a graft biopsy showed epithelioid granuloma in the center of massive mononuclear cell infiltration. She had presented with refractory urinary tract infection treated with antibiotics before biopsy. The case was presumed to be GIN associated with UTI or hypersensitivity to medication. Case 2: a 47-yr-old woman received a second graft from a non-heart-beating donor. A protocol graft biopsy was performed six months after transplantation and showed several granulomatous nodules. She was followed closely without therapy. Case 3: a 27-yr-old woman received an ABO-incompatible kidney from her father. A protocol graft biopsy was performed three months after transplantation and showed granulomatous reaction with severe mononuclear cell infiltration. She received steroid pulse therapy. The two latter patients had no obvious factor contributing to GIN. Therefore, they were presumed to have idiopathic GIN. Infection is considered to be the main causative factor of GIN in renal allografts. This paper describes rare cases of GIN that had no infectious episode in the renal allografts.
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Affiliation(s)
- Kiyohiko Hotta
- Departments of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan.
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27
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Geetha V, Rao L, Monappa V, Susmitha M, Prabhu R. Decoy cells in urine cytology: A useful clue to post-transplant polyoma virus infection. J Cytol 2012; 29:133-4. [PMID: 22787295 PMCID: PMC3391795 DOI: 10.4103/0970-9371.97157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- V Geetha
- Department of Pathology, Kasturbha Medical College and Hospital, Manipal University, Manipal, Karnataka, India
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28
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Keddis M, Leung N, Herrmann S, El-Zoghby Z, Sethi S. Adenovirus-induced interstitial nephritis following umbilical cord blood transplant for chronic lymphocytic leukemia. Am J Kidney Dis 2012; 59:886-90. [PMID: 22405484 DOI: 10.1053/j.ajkd.2011.10.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/25/2011] [Indexed: 11/11/2022]
Abstract
We present a case of a 27-year-old man who received an unrelated donor umbilical cord blood transplant for chronic lymphocytic leukemia. His postsurgery course was complicated by acute kidney injury, hemorrhagic cystitis, and pancytopenia. Transjugular kidney biopsy showed interstitial nephritis. Viral inclusions were present in tubular epithelial cells, and in situ hybridization studies confirmed the presence of adenovirus. Kidney function improved after a short course of cidofovir. Adenovirus-induced interstitial nephritis should be considered in the differential diagnosis in all cases of interstitial nephritis occurring in immunocompromised patients.
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Affiliation(s)
- Mira Keddis
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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29
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Storsley L, Gibson IW. Adenovirus interstitial nephritis and rejection in an allograft. J Am Soc Nephrol 2011. [PMID: 21436288 DOI: 10.1681/asn.2010090941.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Viral infections are an important complication of solid organ transplantation. Although polyoma is the virus that most commonly infects the renal allograft, adenoviral infections are also reported. We describe the clinical and pathologic findings in a patient with adenoviral infection associated with acute rejection of the renal allograft. The pathologic findings of adenovirus infection usually include a granulomatous interstitial nephritis, which is helpful in distinguishing from acute rejection. We discuss the differential diagnosis and pathophysiology of allograft viral infections and concomitant rejection.
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Affiliation(s)
- Leroy Storsley
- Departments of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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30
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Storsley L, Gibson IW. Adenovirus interstitial nephritis and rejection in an allograft. J Am Soc Nephrol 2011; 22:1423-7. [PMID: 21436288 DOI: 10.1681/asn.2010090941] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Viral infections are an important complication of solid organ transplantation. Although polyoma is the virus that most commonly infects the renal allograft, adenoviral infections are also reported. We describe the clinical and pathologic findings in a patient with adenoviral infection associated with acute rejection of the renal allograft. The pathologic findings of adenovirus infection usually include a granulomatous interstitial nephritis, which is helpful in distinguishing from acute rejection. We discuss the differential diagnosis and pathophysiology of allograft viral infections and concomitant rejection.
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Affiliation(s)
- Leroy Storsley
- Departments of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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31
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Varma MC, Kushner YB, Ko DS, Kawai T, Martins PN, Martins P, Kaur P, Markmann JF, Kotton CN. Early onset adenovirus infection after simultaneous kidney-pancreas transplant. Am J Transplant 2011; 11:623-7. [PMID: 21342452 DOI: 10.1111/j.1600-6143.2010.03408.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Adenoviruses (AdV) are increasingly recognized as important viral pathogens in immunocompromised hosts. The clinical spectrum ranges from asymptomatic viremia to allograft dysfunction, and death. Most of the medical literature is on AdV infection in children and bone marrow transplant recipients. We report a case of AdV in an adult recipient in the first month after simultaneous kidney-pancreas transplant with thymoglobulin induction. This is a rare report of adenovirus infection after multiorgan transplant, and is unique in that it exhibited tissue invasive disease without any localizing signs or allograft dysfunction, while other cases in medical literature had invasive disease of the allograft with allograft dysfunction, failure, or death. In addition, this is the first report of a radiologic presentation of AdV nephritis.
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Affiliation(s)
- M C Varma
- Department of Surgery, Division of Transplant Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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32
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Helanterä I, Egli A, Koskinen P, Lautenschlager I, Hirsch HH. Viral Impact on Long-term Kidney Graft Function. Infect Dis Clin North Am 2010; 24:339-71. [DOI: 10.1016/j.idc.2010.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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33
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Kolankiewicz LM, Pullman J, Raffeld M, Kopp JB, Glicklich D. Adenovirus nephritis and obstructive uropathy in a renal transplant recipient: case report and literature review. NDT Plus 2010; 3:388-92. [PMID: 25949439 PMCID: PMC4421518 DOI: 10.1093/ndtplus/sfq024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 02/19/2010] [Indexed: 12/05/2022] Open
Abstract
We report an unusual case of adenoviral nephritis in a 45-year-old woman who presented with fever, gross haematuria, acute kidney injury and obstructive uropathy 17 months following renal transplantation. Adenoviral nephritis was confirmed with immunohistochemistry. We identified 10 other published cases of adenoviral nephritis proven by immunohistochemistry. Obstructive uropathy has been reported only once before in a renal transplant recipient with adenoviral nephritis. Contrary to other reports, this case series shows that renal function may not always recover to baseline following the acute adenoviral disease. Adenoviral nephritis should be considered in the renal transplant patient with fever, haematuria, acute kidney injury and hydronephrosis in both the early and late post-transplant periods.
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Affiliation(s)
| | - James Pullman
- Department of Pathology , Albert Einstein College of Medicine , New York, NY , USA
| | - Mark Raffeld
- Laboratory of Pathology, National Cancer Institute
| | - Jeffrey B Kopp
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Disease , National Institutes of Health , Bethesda, MD , USA
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34
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Abstract
PURPOSE OF REVIEW Adenoviruses are emerging as important viral pathogens in solid organ transplant recipients, impacting morbidity, graft survival and even mortality. This review will discuss the current understanding of the epidemiology, diagnosis and therapy of adenovirus infection in transplant recipients. RECENT FINDINGS Advances in the field include the use of polymerase chain reaction in the diagnosis of adenoviral infection, a better understanding of the epidemiology, immune response and potential new therapies, including preemptive and adoptive immunotherapy strategies. Adenoviral infections appear to be common, especially in pediatric solid organ transplant. Generally well tolerated, some high-risk patients may develop disseminated disease causing graft failure, which may lead to retransplant and/or death. Antiviral therapy and immunotherapy may play a role in these patients, although prospective controlled data are not available at this time. SUMMARY Although new tools and a better understanding of the epidemiology, risk factors and therapies for adenovirus are beginning to materialize, prospective, controlled trials, using careful definitions, and standardized methodologies need to be performed to more fully clarify these issues in solid organ transplant recipients.
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35
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Ortiz M, Ulloa C, Troncoso P, Rabagliati R, Jara A. Hemorrhagic cystitis secondary to adenovirus infection in a kidney transplant recipient: case report. Transplant Proc 2010; 41:2685-7. [PMID: 19716001 DOI: 10.1016/j.transproceed.2009.06.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Increasingly potent immunosuppressive agents have reduced the incidence of rejection of transplanted organs while increasing patient susceptibility to opportunistic infections and cancer. Adenoviruses are increasingly recognized as contributors to morbidity and mortality in stem cell and solid-organ transplant recipients. Clinical findings range from asymptomatic viremia to respiratory and gastrointestinal disease, hemorrhagic cystitis, and severe disseminated illness. We describe the first case in Chile of hemorrhagic adenovirus cystitis after renal transplantation in an adult.
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Affiliation(s)
- M Ortiz
- Department of Nephrology, Pontifical Catholic University of Chile.
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36
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Komiya T, Goto N, Takeda A, Horike K, Onoda H, Sakai K, Kitamura K, Yamamoto K, Oikawa T, Nagasaka T, Hiramitsu T, Simabukuro S, Suzuki K, Sato T, Yoshihiko W, Uchida K, Morozumi K. A case of acute rejection with adenovirus infection after ABO-incompatible kidney transplantation. Clin Transplant 2009; 23 Suppl 20:27-30. [PMID: 19594592 DOI: 10.1111/j.1399-0012.2009.01005.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report clinical and histopathologic findings of a case of acute rejection with adenovirus infection after kidney transplantation. A 63-yr-old woman with end-stage renal disease caused by lupus nephritis received an ABO-incompatible living kidney transplantation from her husband. On the 7th post-operative day (POD), she had fever, hematuria, and bladder irritation. Although she was treated with an antibiotic, the symptoms were not improved. We diagnosed adenovirus infection as positive with the urine shell vial method and blood PCR analysis. Cyclophosphamide was interrupted and immunoglobulin therapy was performed. However, urine output decreased and serum creatinine levels increased. An episode biopsy was performed on POD 20. We diagnosed acute antibody-mediated rejection. She was treated with plasma exchange for acute rejection and antiviral drug (rivabirin) for active adenovirus infection. However, the renal graft dysfunction was deemed irreversible and the renal graft was removed on POD 34. The graftectomy specimen showed acute rejection and acute tubular necrosis with adenovirus infection.
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Affiliation(s)
- Toshiyuki Komiya
- Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
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37
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Hensley JL, Sifri CD, Cathro HP, Lobo P, Sawyer RG, Brayman KL, Hackman RC, Pruett TL, Bonatti HJR. Adenoviral graft-nephritis: case report and review of the literature. Transpl Int 2009; 22:672-7. [PMID: 19210749 DOI: 10.1111/j.1432-2277.2009.00838.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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38
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Barraclough K, Oliver K, Playford EG, Preston J, Campbell S, Johnson DW, Hawley C, Mudge D, van Eps C, Isbel N. Life-threatening adenovirus infection in a kidney transplant recipient. NDT Plus 2009; 2:250-3. [PMID: 25984003 PMCID: PMC4421196 DOI: 10.1093/ndtplus/sfp003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 01/06/2009] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | - John Preston
- Department of Transplant Surgery , Princess Alexandra Hospital , Brisbane , Australia
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39
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Abstract
SUMMARY Human immunodeficiency virus (HIV)-infected patients may acquire new viral co-infections; they also may experience the reactivation or worsening of existing viral infections, including active, smoldering, or latent infections. HIV-infected patients may be predisposed to these viral infections owing to immunodeficiency or risk factors common to HIV and other viruses. A number of these affect the kidney, either by direct infection or by deposition of immune complexes. In this review we discuss the renal manifestations and treatment of hepatitis C virus, BK virus, adenovirus, cytomegalovirus, and parvovirus B19 in patients with HIV disease. We also discuss an approach to the identification of new viral renal pathogens, using a viral gene chip to identify viral DNA or RNA.
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Affiliation(s)
- Meryl Waldman
- Kidney Disease Section, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-1268, USA.
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40
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Gaspert A, Lüthi B, Mueller NJ, Bossart W, Heim A, Wüthrich RP, Fehr T. Subacute allograft failure with dysuria and hematuria in a kidney transplant recipient. Am J Kidney Dis 2009; 54:154-8. [PMID: 19121556 DOI: 10.1053/j.ajkd.2008.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 11/05/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Ariana Gaspert
- Department of Pathology, University Hospital, Zürich, Switzerland
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41
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Emerging Viruses in Transplantation: There Is More to Infection After Transplant Than CMV and EBV. Transplantation 2008; 86:1327-39. [DOI: 10.1097/tp.0b013e31818b6548] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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42
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Chung S, Park CW, Chung HW, Chang YS. Acute renal failure presenting as a granulomatous interstitial nephritis due to cryptococcal infection. Kidney Int 2008; 76:453-8. [PMID: 19644480 DOI: 10.1038/ki.2008.494] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Sungjin Chung
- Division of Nephrology, Department of Internal Medicine, St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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43
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Abstract
A five-yr-old girl, who was a renal transplant recipient, presented with nausea, vomiting, epigastric discomfort, papules, and vesicles on her body. She was diagnosed with acute pancreatitis and varicella zoster infection because her serum amylase and lipase levels were positive. Fourteen months later, she was readmitted with nausea, vomiting, and epigastric pain similar to the previous symptoms and was diagnosed with acute pancreatitis. This case report indicates that acute pancreatitis can be one of a number of complications following pediatric renal transplantation and can recur because of various causes.
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Affiliation(s)
- Min Hyun Cho
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea.
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44
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Yamamoto I, Yamaguchi Y, Horita S, Tanabe K, Toma H. Granulomatous tubulointerstitial nephritis in early renal allograft: a case report. Clin Transplant 2007. [DOI: 10.1111/j.1399-0012.2007.00713.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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45
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Nickeleit V, Singh HK, Mihatsch MJ. Latent and Productive Polyomavirus Infections of Renal Allografts. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2007; 577:190-200. [PMID: 16626037 DOI: 10.1007/0-387-32957-9_14] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Polyomavirus allograft nephropathy, also termed BK virus nephropathy (BKN) after the main causative agent, the polyoma-BK-virus strain, is a major complication following kidney transplantation. BKN is the most common viral infection affecting the renal allograft with a reported prevalence of 1% up to 10%. It often leads to chronic allograft dysfunction and graft loss. BKN is most likely caused by the reactivation of latent BK viruses which, under sustained and intensive immunosuppression, enter a replicative/productive cycle. Viral disease, i.e., BKN, is typically limited to the kidney transplant. It is histologically defined by the presence of intranuclear viral inclusion bodies in epithelial cells and severe tubular injury. Virally induced tubular damage is the morphological correlate for allograft dysfunction. In this chapter, different variants of polyomavirus intranuclear inclusion bodies [types 1 through 4] and adjunct techniques [immunohistochemistry, in-situ hybridization, electron microscopy and polymerase chain reaction (PCR)] that are used for proper characterization of disease are described. Special emphasis is placed on the clinical and pathophysiological significance of different histological stages of BKN.
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46
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Singh HK, Bubendorf L, Mihatsch MJ, Drachenberg CB, Nickeleit V. Urine cytology findings of polyomavirus infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2007; 577:201-12. [PMID: 16626038 DOI: 10.1007/0-387-32957-9_15] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Polyomaviruses of the BK- and JC-strains often remain latent within the transitional cell layer of the bladder, ureters and the renal pelvis as well as in tubular epithelial cells of the kidney. Slight changes in the immune status and/or an immunocompromised condition can lead to the (re)activation of latent polyomaviruses, especially along the transitional cell layer, resulting in the shedding of viral particles and infected cells into the urine. A morphologic sign of the (re)activation of polyomaviruses is the detection of typical intranuclear viral inclusion bearing epithelial cells, so-called "decoy cells", in the urine. Decoy cells often contain polyoma-BK-viruses. The inclusion bearing cells are easily identified and quantifiable in routine Papanicolaou stained urine cytology specimens. With some experience, decoy cells can also be detected in the unstained urinary sediment by phase contrast microscopy. Different morphologic variants of decoy cells (types 1 through 4) are described and ancillary techniques (immunohistochemistry, electron microscopy (EM), and fluorescence-in-situ-hybridization (FISH)) for proper identification and characterization are discussed. Special emphasis is placed on the clinical significance of the detection of decoy cells as a parameter to assess the risk for disease, i.e., polyoma-BK-virus nephropathy (BKN) in kidney transplant recipients. The sensitivity and specificity of decoy cells for diagnosing BKN is 99% and 95%, respectively, the positive predictive value varies between 27% and more than 90%, and the negative predictive value is 99%. The detection of decoy cells is compared to other techniques applicable to assess the activation of polyomaviruses in the urine (polymerase chain reaction (PCR) and EM).
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47
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Nickeleit V, Mihatsch MJ. Polyomavirus nephropathy in native kidneys and renal allografts: an update on an escalating threat. Transpl Int 2006; 19:960-73. [PMID: 17081225 DOI: 10.1111/j.1432-2277.2006.00360.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Polyomavirus nephropathy, also termed BK-virus nephropathy (BKN) after the main causative agent, the polyoma-BK-virus strain, is a significant complication after kidney transplantation. BKN is the most common viral infection that affects renal allografts with a prevalence of 1-9% on average 8-13 months post surgery. It can also occur sporadically in native kidneys. Viral nephropathy is caused by the (re)activation of latent BK viruses that enter into a replicative cycle under sustained and intensive immunosuppression. Pure productive kidney infections with JC- and SV-40 polyomaviruses are exceptionally rare. BKN is morphologically defined by the presence of intranuclear viral inclusion bodies in epithelial cells and tubular injury, which is the morphological correlate for renal dysfunction. Renal disease can progress through different histologic stages (from early BKN stage A to late fibrotic stage C) that carry prognostic significance; disease stages B and C often result in chronic kidney (allograft) dysfunction and end-stage renal disease. The clinical goal is to diagnose viral nephropathy in disease stage A and to limit chronic renal injury. Strategies to recognize, classify, and manage BKN are critically discussed including ancillary techniques for risk assessment and patient monitoring: (i) urine cytology and the search for so-called 'decoy cells'; (ii) PCR analyses for viral load measurements in the plasma and urine; and (iii) negative staining urine electron microscopy to identify viral particles.
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Affiliation(s)
- Volker Nickeleit
- Nephropathology Laboratory, Department of Pathology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7525, USA.
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48
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Abstract
Adenoviral disease in pediatric SOT recipients is emerging as an important viral pathogen, with serious consequences impacting morbidity, mortality and graft survival. The optimal diagnostic techniques, as well as therapy have yet to be established. This article reviews the current epidemiology of AdV in orthotopic liver, intestinal, cardiothoracic and renal transplant recipients. Issues related to diagnosis, notably the use of newer non-culture based viral detection methods and therapy, including anti-adenoviral agents and adoptive immunotherapy are discussed.
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Affiliation(s)
- Jill A Hoffman
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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49
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Nanovic L, Becker YT, Hedican S, Hofmann RM. Sudden Late Onset of Gross Hematuria in a Previous Renal Transplant Recipient 3 Months After Transplant Nephrectomy. Am J Kidney Dis 2005; 46:e91-4. [PMID: 16253716 DOI: 10.1053/j.ajkd.2005.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 08/04/2005] [Indexed: 11/11/2022]
Abstract
Causes of gross hematuria in a patient with end-stage renal disease are limited compared with those in patients with normal renal function. Given the increased likelihood of patients with end-stage renal disease developing renal cell carcinoma, the workup focuses on a careful evaluation of the collecting system. The workup for gross hematuria in a renal transplant recipient is similar; however, the focus shifts toward a more thorough evaluation of the transplanted kidney and bladder because immunosuppression increases the overall risk for malignancy. An immunosuppressed patient also is at risk for infectious processes in the transplanted kidney manifesting as gross hematuria. Concerns for chronic rejection also should be investigated, although microscopic hematuria is more common in this scenario. If this is unrevealing, then close scrutiny of the native kidneys for possible sources of bleeding is warranted. We present an interesting and unusual cause of painless gross hematuria in a patient with end-stage renal disease and transplant nephrectomy 3 months before the onset of bleeding.
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Affiliation(s)
- Lisa Nanovic
- Department of Transplant Surgery, University of Wisconsin, Fitchburg, WI 53713, USA
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50
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Lim AKH, Parsons S, Ierino F. Adenovirus tubulointerstitial nephritis presenting as a renal allograft space occupying lesion. Am J Transplant 2005; 5:2062-6. [PMID: 15996261 DOI: 10.1111/j.1600-6143.2005.00945.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This report describes a case of adenovirus infection in a renal allograft 36 days after transplantation that presented with transient macroscopic hematuria, prominent systemic features and acute renal dysfunction. The patient had persistent high fevers despite broad antibiotic cover. A CT scan demonstrated a new discrete space occupying lesion in the allograft, which was devoid of blood flow on Doppler sonography. A targeted renal biopsy showed florid and focal necrotizing interstitial nephritis with intranuclear tubular viral inclusions. Treatment with ganciclovir and reduction in immunosuppression resulted in a rapid improvement. Immunohistochemistry and electron microscopy confirmed adenovirus infection. This case demonstrates an uncommon presentation of necrotizing adenoviral nephropathy, which should be considered in cases of renal allograft mass lesions.
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Affiliation(s)
- Andy Kim Ho Lim
- Department of Nephrology, Austin Health, Studley Road, Heidelberg, Melbourne, Victoria 3084, Australia
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