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Diagnosis: Adenovirus Interstitial Nephritis

Adenoviruses are a family of double-stranded DNA viruses that infect human epithelial cells exhibiting a characteristic cytopathic effect. While most infections for adenoviruses are self-limiting, those occurring in immunocompromised hosts can be more severe, or even fatal. The most common urologic manifestation of adenovirus infection in adults is haemorrhagic cystitis. In the immunocompromised patient, adenovirus, specifically subgroup B types 11, 34 and 35, has been shown to cause both haemorrhagic cystitis and tubulointerstitial nephritis. There have been multiple case reports of adenovirus-related renal allograft tubulointerstitial nephritis over the past 30 years. Typical pathological findings in adenovirus nephropathy include tubular cell necrosis associated with severe interstitial inflammation and viral cytopathic effects including peripheral condensed chromatin, basophilic nuclear inclusions and nuclear enlargement (Rady K, et al. Allograft adenovirus nephritis. Clin Kidney J. 2014;7(3):289-92. [PubMed link]). Sometimes inflammation has a subtle granulomatous appearance.

There is no consensual therapeutic approach for nephritis associated with adenovirus infection. Treatment strategies are based on case reports and series of cases, which include immunosuppression tapering and specific antiviral therapy, such as IVIG, pulse–dose steroids, cidofovir, ribavirin or valganciclovir, in varying combinations, with or without reduction in immunosuppression (Moreira C, et al. Adenovirus infection-A rare cause of interstitial nephritis in kidney transplant. Nefrologia. 2018. pii: S0211-6995(18)30101-2. [PubMed link]).

See the chapter: Transplantation Pathology- Infections (only Spanish version) of our Tutorial.

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