Clinicopathologic Characteristics of JC Virus Nephropathy in Kidney Transplant Recipients

Abstract

Background. The vast majority of polyomavirus nephropathy (PVN) is due to BK virus, but rare cases result from JC virus reactivation. To date, only a handful of biopsy-proven JC-PVN cases have been reported. Here, we describe the clinical and pathologic findings in 7 patients with biopsy-proven JC-PVN. Methods. Search of the pathology archives at 2 institutions found 7 cases of JC-PVN. Clinical data were extracted from the electronic medical records, and the biopsies were reviewed. Results. Four cases were diagnosed at 6 y posttransplant or later. The remaining 3 cases presented within approximately 2 y posttransplant, of which 2 showed subclinical JC-PVN on surveillance biopsy. Two early presenting patients were treated for acute rejection just before acquiring JC-PVN. Late presenting patients had higher chronicity, which correlated to worse outcome. All but 1 biopsy showed nonspecific inflammation within areas of interstitial fibrosis without significant inflammation in unscarred cortex. The earliest presenting patient was the exception and showed active inflammation with tubulitis. Viral cytopathic changes were detected in all cases with moderate or high-histologic viral load (pvl), showing preference for the distal tubules and medulla. The 2 cases with low pvl did not demonstrate cytopathic changes but were SV40 positive. Conclusions. JC-PVN can be insidious in presentation, which may cause delayed or missed diagnosis. Unlike BK-PVN, which typically occurs early in the posttransplant period, JC-PVN can occur both early and late following transplant. Overreliance on negative plasma and urine BK viral loads to exclude PVN can be a pitfall.

Metagenomic Next-Generation Sequencing Reveals the Profile of Viral Infections in Kidney Transplant Recipients During the COVID-19 Pandemic

“…Herpesvirus infections, especially CMV infection, have also been well studied ( 27 , 29 , 30 ). The number of studies on JCV infection is also increasing ( 31 , 32 ). We also detected TTV ( 33 – 35 ) and parvovirus B19 ( 36 – 38 ), which are still relatively rare in the field of transplantation.…”

Urinary Tract Infections: Virus

“…Conversely, Boldorini et al (2003) first reported morphological evidence of lytic JC virus infection in four renal specimens from AIDS patients, supporting the hypothesis that, in immunocompromised patients, active JC viral replication can also occur in the kidney and urinary tract. JC virus-related nephropathy is now recognized as a rare cause of nephropathy in transplant recipients ( Wiegley et al, 2021 ). Ureteral and bladder involvement is more rarely reported in different types of immunosuppressed patients ( Cavallo et al, 2007 ).…”

JC Polyomavirus and Transplantation: Implications for Virus Reactivation after Immunosuppression in Transplant Patients and the Occurrence of PML Disease

“…In a study by Lopez et al, they estimated the incidence of JCV viruria to be around 25% [33]. Wiegley et al observed that, unlike BKV infection, which occurs early post-transplantation, JCV nephropathy occurs at both early and late times after renal transplantation, and that differential diagnosis for BKV may be problematic [34].…”