Case
191 Diagnosis |
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Diagnosis: Cytomegalovirus Nephritis and Cellular Acute Rejection
Although cytomegalovirus (CMV) infection and disease is relatively frequent in renal transplant patients, direct infection of the renal graft (CMV nephritis) is uncommon, with a prevalence close to 0.2% (Swanson KJ, et al. Cytomegalovirus nephritis in kidney transplant recipients: Epidemiology and outcomes of an uncommon diagnosis. Transpl Infect Dis. 2021;23(5):e13702. [PubMed link]).Viral inclusions can be identified in tubular epithelial cells, endothelial cells, and podocytes. These inclusions are usually somewhat different from those of Poliomvirus and Adenovirus, being only nuclear (at least with light microscopy) in the latter two, and nuclear and cytoplasmic in CMV, as seen in figure 4 of the case. Immunohistochemistry for CMV confirmed the diagnosis given by light microscopy. In our experience, it is relatively easy to distinguish CMV inclusions from those of Polyoma and Adenovirus.
It has been known for a long time that CMV reactivation and disease are associated with graft rejection, possibly due to overexpression of HLA molecules that would induce viral replication.
The prognosis of renal graft in CMV nephritis is variable; early detection and prompt treatment would limit kidney damage (due to infection and possible associated rejection), however, in many cases there is decreased graft survival.
Visit the Chapter: Kidney Transplantation Pathology of our Tutorial (this chapter has only Spanish version, however, you can use an automatic translator such as google translate).
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References
- Swanson KJ, Djamali A, Jorgenson MR, Misch EA, Ghaffar A, Zhong W, Aziz F, Garg N, Mohamed M, Mandelbrot D, Parajuli S. Cytomegalovirus nephritis in kidney transplant recipients: Epidemiology and outcomes of an uncommon diagnosis. Transpl Infect Dis. 2021;23(5):e13702. [PubMed link].
- Udomkarnjananun S, Phulkerd T, Thammathiwat T, Townamchai N, Surinrat E, Tiankanon K, Surintrspanont J, Iampenkhae K, Vanichanan J, Jutivorakool K, Avihingsanon Y, Praditpornsilpa K. Cytomegalovirus tubulo-glomerulitis and intratubular granuloma: Key histopathological findings in allograft cytomegalovirus infection. Nephrology (Carlton). 2021;26(4):369-370 [PubMed link].
- Posadas Salas MA, Thompson J, Kadian M, Ngo T, Bruner E, Self S. Cytomegalovirus renal infection: Rare manifestation of a common post-transplant viral infection-A case series. Transpl Infect Dis. 2019;21(6):e13169 [PubMed link].
- Hasanzamani B, Hami M, Zolfaghari V, Torkamani M, Ghorban Sabagh M, Ahmadi Simab S. The effect of cytomegalovirus infection on acute rejection in kidney transplanted patients. J Renal Inj Prev. 2016;5(2):85-8. [PubMed link]