Sekar Aravind, Nada Ritambhra, Kohli Harbir S, Sharma Ashish
Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Nephrol. 2022 Nov-Dec;32(6):637-639. doi: 10.4103/ijn.ijn_336_21. Epub 2022 Oct 2.
Polyomavirus nephropathy (PVN) is a known complication of renal transplantation due to the reactivation of latent BK virus (BKV) infection. Viral replication is usually confined to tubules. However, in severe viremia and late stages of PVN, it can involve glomerular parietal epithelial cells. Glomerular involvement by BKV can cause crescent formation and may lead to graft failure. We describe a relatively rare case of PVN with glomerular involvement and crescent formation in a 52-year-old male who had undergone a transplant 16 months ago. Despite the stoppage of immunosuppression, graft failure occurred eventually. Interestingly, we observed the intense positivity for IgG and c4d in the Bowman capsule on immunofluorescence. Observation of such positivity along Bowman capsule in renal biopsies with a limited number of glomeruli should alert pathologists to do a vigilant search of BKV inclusion and perform immunohistochemistry for SV 40 large T antigen.
多瘤病毒肾病（PVN）是肾移植已知的一种并发症，由潜伏的BK病毒（BKV）感染重新激活所致。病毒复制通常局限于肾小管。然而，在严重病毒血症和PVN晚期，它可累及肾小球壁层上皮细胞。BKV累及肾小球可导致新月体形成，并可能导致移植肾失功。我们描述了一例相对罕见的PVN病例，该病例发生于一名52岁男性，在16个月前接受了肾移植，出现了肾小球受累及新月体形成。尽管停用了免疫抑制剂，但最终仍发生了移植肾失功。有趣的是，我们在免疫荧光检查中观察到鲍曼囊内IgG和C4d呈强阳性。在肾小球数量有限的肾活检中，沿鲍曼囊观察到这种阳性结果应提醒病理学家警惕寻找BKV包涵体，并对SV 40大T抗原进行免疫组织化学检查。
