Adenoviral graft-nephritis: case report and review of the literature

Adenovirus Interstitial Nephritis and Rejection in an Allograft

“…10 A range of outcomes have been reported, from rapid clearing of the virus and recovery of allograft function to fatal outcomes. 3 The optimal treatment strategy is not clear; our patient received an initial steroid pulse for suspected rejection, followed by a reduction in immunosuppression for confirmed ADV infection, followed by yet another steroid pulse and IVIG for biopsyproven rejection, and lastly a more sustained reduction in immunosuppression to assist with clearing of the virus. The essentially normal allograft biopsy 6 weeks after the first biopsy demonstrates a remarkable recovery from both ADV and/or rejection-related inflammatory injury, and highlights the potential for good longer term prognosis of ADV nephritis after viral clearance compared with the often protracted infection of polyomavirus nephropathy with associated chronic graft injury.…”

“…2 ADV infection of the allograft itself appears to be much less common, although numerous case reports exist. 3 Patients usually present with hemorrhagic cystitis and hematuria, fever, or both.…”

Viral infections directly involved in kidney allograft function

“…There have been many individual case reports of ADV nephritis . Pathological findings of ADV nephritis are characterized by widespread interstitial mononuclear inflammation, which is difficult to distinguish from acute T‐cell‐mediated rejection (Fig.…”

“…Renal tubules show tubulitis accompanied by tubular destruction, necrosis and viral cytopathic effects, including nuclear enlargement, peripheral condensed chromatin and basophilic nuclear inclusions representing viral particles . There are some reports that show ADV‐infected cells by in situ hybridization or immunohistochemical staining, but unfortunately, there is no commercial antibody with high reliability for ADV staining. Under electron microscopy, 70–80 nm viral particles are visible within the tubular epithelial cells …”

A Case of Late Kidney Allograft Failure

“…Typical presentation is AKI accompanied by microscopic hematuria but gross hematuria may also occur. More recently, adenoviral infection of the transplanted kidney may also be seen similarly presenting with microscopic or gross hematuria (17,25). In this context, a study of the transplant and native kidneys to evaluate for structural lesions that may incite hematuria, such as calculi or tumors, is necessary.…”