Suh Kwang-Sun, Kim Suk Yeong, Bang Byung Kee, Yang Chul Woo, Lee Jong Min, Park Joo Hyun, Kim Sung Kwon
Department of Pathology, Chungnam National University School of Medicine, 6 Jung-gu, Munwha-1-dong, Daejeon, Korea 301-131.
Ultrastruct Pathol. 2003 Jan-Feb;27(1):61-4. doi: 10.1080/01913120309948.
Human polyomavirus (PV) interstitial nephritis has recently been recognized as a cause of severe renal allograft dysfunction. It occurs in immunosuppressed patients after reactivation of the latent virus PV type BK (BK virus) in the renal epithelium. BK disease is defined as a morphologically manifest renal infection with cytopathic signs accompanied by varying degrees of interstitial inflammatory cell infiltrates and functional impairment. It is also identified by the presence of cells containing viral inclusion bodies (decoy cells) in the urine. The authors report a case of BK PV interstitial nephritis in a 36-year-old renal allograft recipient. Under light microscopy the chief diagnostic indicator was detection of intranuclear viral inclusions, which were found exclusively in tubular epithelial cells. Cells with viral changes were often enlarged with nuclear atypia and chromatin basophilia. Widespread interstitial plasma cell infiltrates associated with tubulitis were present. Intranuclear paracrystalline arrays of virus particles 35-38 nm in diameter were present as characteristic ultrastructural indicators. Urine samples revealed decoy cells with ground-glass-type intranuclear inclusions positive for BK virus by electron microscopy.
人多瘤病毒（PV）间质性肾炎最近被认为是严重肾移植功能障碍的一个病因。它发生在免疫抑制患者中，是由潜伏在肾上皮细胞中的BK型多瘤病毒（BK病毒）重新激活所致。BK病被定义为一种形态学上表现为有细胞病变体征的肾脏感染，伴有不同程度的间质炎性细胞浸润和功能损害。尿液中出现含有病毒包涵体的细胞（诱饵细胞）也可作为其诊断依据。作者报告了一例36岁肾移植受者发生BK PV间质性肾炎的病例。在光学显微镜下，主要诊断指标是检测到核内病毒包涵体，其仅在肾小管上皮细胞中发现。发生病毒变化的细胞常肿大，伴有核异型性和染色质嗜碱性。存在广泛的间质浆细胞浸润并伴有肾小管炎。直径为35 - 38 nm的病毒颗粒核内平行排列晶体是其特征性超微结构指标。尿液样本通过电子显微镜检查发现诱饵细胞，其核内有玻璃样包涵体，BK病毒检测呈阳性。
