Adenovirus nephritis and obstructive uropathy in a renal transplant recipient: case report and literature review

Abstract

We report an unusual case of adenoviral nephritis in a 45-year-old woman who presented with fever, gross haematuria, acute kidney injury and obstructive uropathy 17 months following renal transplantation. Adenoviral nephritis was confirmed with immunohistochemistry. We identified 10 other published cases of adenoviral nephritis proven by immunohistochemistry. Obstructive uropathy has been reported only once before in a renal transplant recipient with adenoviral nephritis. Contrary to other reports, this case series shows that renal function may not always recover to baseline following the acute adenoviral disease. Adenoviral nephritis should be considered in the renal transplant patient with fever, haematuria, acute kidney injury and hydronephrosis in both the early and late post-transplant periods.

Keywords: adenovirus nephritis; obstructive uropathy; renal transplant.

Fig. 1

Renal transplant ultrasound. The renal ultrasound image shows the renal allograft in the right lower quadrant of the abdomen. The allograft measures 12.7 cm in the long axis and demonstrates moderate hydronephrosis.

Fig. 2

Localization of adenoviral antigen in the renal allograft. (A) Renal allograft biopsy revealed interstitial nephritis, with numerous mildly atypical lymphocytes, focal necrosis and haemorrhage. Arrow indicates a tubular epithelial cell nucleus with apparent viral cytopathic changes. Haematoxylin and eosin, original magnification ×400. (B and C) Immunostaining for adenovirus antigens labelled several tubular cell nuclei and, more faintly, adjacent cytoplasm (dark brown diaminobenzidine product; haematoxylin counterstain; original magnification ×400).