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RENAL TRANSPLANTASYON OLGUSUNDA VİRAL TÜBÜLOİNTERSTİSYEL NEFRİT (OLGU SUNUMU)

TUBULOINTERSTITIAL VIRAL NEPHRITIS IN A RENAL ALLOGRAFT RECIPIENT (CASE REPORT)

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2002

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Polyomavirüs, type BK is an important viral infection of the allograft kidney. Although BKV infected urethelial cell can be encountered frequently urinal infection, it is unlikely to found renal infection in renal allograft biopsies (RAB). In this study one renal transplant recipient with two RAB showed tubulointerstitial inflammation besides intranuclear inclusions and nuclear pleomorphism in tubular epithelial cells which characterized as tubulo-interstitial viral infection and the responsible agent was thought to be BKV primarily. Because pathological features persisted and acute rejection could not be excluded in the second RAB, antirejection therapy was administered and and a partial response was observed. Immunosupression was gradually reduced during the longfollow up. At this period creatinine levels remained stable. This case is still followed as a 4,5 year functional graft. RAB is a considered a golden standard in detecting dysfunctions in the allograft. Pathological features other than rejection can be observed in biopsies and they may overlap with viral infection and rejection findings. Epithelial intranuclear inclusions and nuclear polymorphism should remind the possibility of BKV nephropathy which is rarely seen.
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Abstract (Original Language): 
Polyomavirüs, BK tipi (BKV) renal transplantasyon (RT) olgularında önemli bir viral infeksiyon etkenidir. BKV enfekte üretelial hücreler RT olgularının idrar örneklerinde sık saptanmasına karşın renal allograft biopsisinde (RAB) infeksiyon bulgularının saptanması nadirdir. Bu çalışmada RT uygulanan bir olgunun iki RAB'sinde yangısal infiltrasyon yanısıra tübül epitel hücrelerinde intranükleer inklüzyonlar ve nükleer pleomorfizm ile karakterize tübülo interstisyel viral enfeksiyon bulguları saptanmış, etken olarak öncelikle BKV düşünülmüştür. ikinci biopside bulguların sürmesi ve akut rejeksiyonun ekarte edilememesi nedeniyle antirejeksiyon tedavi yapılmış ve kısmi bir yanıt gözlenmiştir. Uzun izlem sürecinde immunsüpresyon tedrici olarak azaltılmıştır. Bu periodta olgunun kreatinin değerleri stabil olarak kalmıştır. Olgu 4,5 yıl sonunda fonksiyone graft ile izlemdedir. RAB graft disfonksiyon nedenini saptamada altın standart olarak kabul edilmektedir. Biopside rejeksiyon dışı patolojilerde olabilir ve viral enfeksiyon bulguları, histopatolojik olarak rejeksiyon bulguları ile örtüşebilir. Epitel hücrelerinde intranükleer inklüzyonlar ve nükleer pleomorfizm nadir olan BKV nefropatisi olasılığını akla getirmelidir.
FULL TEXT (PDF): 
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  • 3
177-181
  • Turkish

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