Mori K, Yoshihara T, Nishimura Y, Uchida M, Katsura K, Kawase Y, Hatano I, Ishida H, Chiyonobu T, Kasubuchi Y, Morimoto A, Teramura T, Imashuku S
Department of Pediatrics, Matsushita Memorial Hospital, Osaka, Japan.
Bone Marrow Transplant. 2003 Jun;31(12):1173-6. doi: 10.1038/sj.bmt.1704077.
Management of post-transplant complications caused by severe adenoviral infection remains a major therapeutic challenge. A 17-year-old male who had undergone bone marrow transplantation for the treatment of acute lymphoblastic leukemia developed complete anuria following hemorrhagic cystitis 34 days after the transplant procedure. The computed tomogram scan revealed bilateral hydronephrosis, indicating acute renal failure because of obstructive uropathy. The emergency procedure of percutaneous nephrostomy caused massive bleeding in the left kidney, which eventually required a nephrectomy. Adenovirus-positive severe necrotizing tubulointerstitial nephritis was the histopathological diagnosis. Post-transplant acute renal failure because of hydronephrosis, which could be complicated by adenovirus-induced renal parenchymal disease, is of great concern and may cause significant problems with interventional treatment.
严重腺病毒感染引起的移植后并发症的管理仍然是一个重大的治疗挑战。一名17岁男性因急性淋巴细胞白血病接受骨髓移植，在移植手术后34天出现出血性膀胱炎后完全无尿。计算机断层扫描显示双侧肾积水，提示因梗阻性尿路病导致急性肾衰竭。经皮肾造瘘的紧急手术导致左肾大量出血，最终需要进行肾切除术。组织病理学诊断为腺病毒阳性的严重坏死性肾小管间质性肾炎。因肾积水导致的移植后急性肾衰竭，可能并发腺病毒诱导的肾实质疾病，令人高度关注，且可能给介入治疗带来重大问题。
