Literature review of allograft adenovirus nephritis and a case presenting as mass lesions in a transplanted kidney without symptoms of urinary tract infection or acute kidney injury

• Published in: Transplant infectious disease Vol. 23; no. 2; pp. e13468 - n/a
• Main Authors: Watanabe, Megumi, Kaneko, Shuzo, Usui, Joichi, Takahashi, Kazuhiro, Kawanishi, Kunio, Takahashi‐Kobayashi, Mayumi, Shimizu, Tatsuya, Ishii, Ryota, Tawara, Takashi, Tsunoda, Ryoya, Nagai, Kei, Kawamura, Tetsuya, Fujita, Akiko, Kai, Hirayasu, Morito, Naoki, Saito, Chie, Oda, Tatsuya, Nagata, Michio, Yamagata, Kunihiro
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.04.2021
• Subjects: acute lobar nephritis (ALN); adenovirus (AdV); Adenoviruses; AdV nephritis (AdVN); Biopsy; Bone marrow; Bone marrow transplantation; Computed tomography; Cystitis; Fever; Hematopoietic stem cells; Hemorrhage; Hemorrhagic cystitis; Infections; Injuries; Kidney transplantation; kidney transplantation (KT); Kidney transplants; Kidneys; Lesions; Literature reviews; Localization; mass lesions; Nephritis; Polymerase chain reaction; Renal function; Stem cells; Transplants & implants; Urinary tract; Urinary tract diseases; Urinary tract infections; Urogenital system; AdV nephritis (AdVN); kidney transplantation (KT); mass lesions; adenovirus (AdV); acute lobar nephritis (ALN)
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.13468

Adenovirus (AdV) infection is a common complication in bone marrow/hematopoietic stem cell transplant and solid organ transplant recipients. AdV infection usually presents as hemorrhagic cystitis, but sometimes it can progress to acute kidney injury showing AdV nephritis (AdVN). We present the case of a 52‐year‐old Japanese female who had received a living kidney transplantation (KT) from her husband. At 21 months post‐KT, the patient presented with a fever, but no renal dysfunction and no abnormal urine findings. A contrast‐enhanced computed tomography (CT) scan revealed a few mass lesions with hypoperfusion in the transplanted kidney. An enhanced CT‐guided biopsy targeting one of these lesions revealed a necrotizing tubulointerstitial nephritis suggesting AdVN. The polymerase chain reaction tests for ADV were negative in a urine sample but positive in the sera and the frozen kidney biopsy samples. AdVN can manifest as an unusual pattern of acute lobar nephritis/acute focal bacterial nephritis‐like localization without symptoms of acute kidney injury or urinary tract infection. Enhanced CT can provide clues for clinical diagnosis.