Location
Suwanee, GA
Start Date
15-5-2018 1:00 PM
Description
Background: Adenoviruses (AdV) are double-stranded DNA viruses that are well recognized as cause of significant morbidity and allograft dysfunction in transplant recipients. Adenovirus nephritis (AdN) can present with hemorrhagic cystitis or tubulointerstitial nephritis. Histological evaluation demonstrates interstitial inflammation, granulomas. Here we report 8 cases of AdN in kidney transplant recipients and their clinical course, management, and outcomes.
Methods: A retrospective search to identify cases of AdN in renal transplant recipients from 2009-2016 at the Emory Transplant Center.
Results: The diagnosis of AdN was confirmed by immunostaining on kidney transplant. All patients presented with complaints of constitutional symptoms; fever, dysuria, hematuria, and proteinuria. The peak serum creatinine increased by a median of 83% from baseline (range 40 to 800%).
Treatment in the cases varied: supportive care alone, Ribavirin, Ribavirin and IVIG, and Brincidofovir (BCD). Of the 2 that did not receive AdV-directed therapy, 1 had resolution of viremia after 42 days. The other had a benign clinical course. The 4 who received ribavirin cleared at a median of 78 days. The 1 who received BCD cleared at 22 days. Proteinuria and hematuria improved or resolved in all.
Conclusions: Treatment varied, with resolution most impressive in the case treated with BCD. There is need to account for the management of simultaneous rejections, and potential side effects of the therapeutics.
Embargo Period
8-14-2018
Adenovirus Nephritis in Kidney Transplant Recipients: Clinical Features and Management
Suwanee, GA
Background: Adenoviruses (AdV) are double-stranded DNA viruses that are well recognized as cause of significant morbidity and allograft dysfunction in transplant recipients. Adenovirus nephritis (AdN) can present with hemorrhagic cystitis or tubulointerstitial nephritis. Histological evaluation demonstrates interstitial inflammation, granulomas. Here we report 8 cases of AdN in kidney transplant recipients and their clinical course, management, and outcomes.
Methods: A retrospective search to identify cases of AdN in renal transplant recipients from 2009-2016 at the Emory Transplant Center.
Results: The diagnosis of AdN was confirmed by immunostaining on kidney transplant. All patients presented with complaints of constitutional symptoms; fever, dysuria, hematuria, and proteinuria. The peak serum creatinine increased by a median of 83% from baseline (range 40 to 800%).
Treatment in the cases varied: supportive care alone, Ribavirin, Ribavirin and IVIG, and Brincidofovir (BCD). Of the 2 that did not receive AdV-directed therapy, 1 had resolution of viremia after 42 days. The other had a benign clinical course. The 4 who received ribavirin cleared at a median of 78 days. The 1 who received BCD cleared at 22 days. Proteinuria and hematuria improved or resolved in all.
Conclusions: Treatment varied, with resolution most impressive in the case treated with BCD. There is need to account for the management of simultaneous rejections, and potential side effects of the therapeutics.