Krystel-Whittemore Melissa, McCarthy Ellen T, Damjanov Ivan, Fields Timothy A
Department of Pathology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
BMJ Case Rep. 2015 Aug 28;2015:bcr2015211564. doi: 10.1136/bcr-2015-211564.
Polyomavirus nephropathy is commonly seen in the renal allograft setting but is uncommon in native kidneys. This paper describes polyomavirus nephropathy that developed in the native kidneys of a patient following immunosuppressive therapy for rheumatoid arthritis/Sjögren's syndrome associated lung disease. The patient presented with dyspnoea and a slow steady rise in serum creatinine. Owing to chronic immunosuppression, calcineurin-inhibitor toxicity was suspected. However, renal biopsy revealed polyomavirus nephropathy. The treatment of choice, lowered immunosuppression, was complicated by exacerbation of the patient's lung disease. This case highlights features of polyomavirus nephropathy in the native kidney, as well as the difficulty in its treatment when immunosuppressive treatment is necessary for medical comorbidities.
多瘤病毒肾病常见于肾移植受者，但在正常肾脏中并不常见。本文描述了一名类风湿关节炎/干燥综合征相关肺部疾病患者在接受免疫抑制治疗后，其正常肾脏发生的多瘤病毒肾病。该患者出现呼吸困难，血清肌酐缓慢稳步上升。由于长期免疫抑制，怀疑是钙调神经磷酸酶抑制剂中毒。然而，肾活检显示为多瘤病毒肾病。首选治疗方法是降低免疫抑制，但患者的肺部疾病加重，使治疗变得复杂。该病例突出了正常肾脏中多瘤病毒肾病的特征，以及当因合并症需要进行免疫抑制治疗时，其治疗的困难性。
