Udomkarnjananun Suwasin, Iampenkhae Kroonpong
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn Univeristy and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
Excellence Center for Organ Transplantation (ECOT), King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
Biomedicines. 2023 Jul 5;11(7):1902. doi: 10.3390/biomedicines11071902.
Infectious agents can pose a significant challenge in kidney transplantation, as they have the potential to cause direct infections in the transplanted kidney. These infections can lead to a decline in kidney function and reduce the longevity of the transplanted kidney. Common post-transplant allograft infections include bacterial pyelonephritis and the BK virus infection, while adenovirus, JC virus, and cytomegalovirus are less frequent but can also lead to significant allograft dysfunctions. The histopathological features of these infections are characterized by the infiltration of inflammatory cells in the kidney interstitial area and the presence of viral nuclear inclusions or cytopathic changes in the renal tubular epithelial cells. The confirmation of causative organisms can be achieved by immunohistochemical staining or the visualization of viral particles using electron microscopic examination. However, these methods typically require a longer turnaround time and are not readily available in developing countries, unlike standard hematoxylin-eosin staining. Notably, the differential diagnosis of interstitial inflammation in kidney allografts almost always includes T cell-mediated rejection, which has a different treatment approach than allograft infections. The aim of this review was to prompt clinicians to identify diverse pathological alterations as observed in kidney allograft biopsies, thereby facilitating further investigations and the management of suspected kidney allograft infections.
感染因子在肾移植中可能构成重大挑战，因为它们有可能在移植肾中引发直接感染。这些感染会导致肾功能下降，并缩短移植肾的存活时间。常见的移植后同种异体移植感染包括细菌性肾盂肾炎和BK病毒感染，而腺病毒、JC病毒和巨细胞病毒感染虽较少见，但也可导致严重的同种异体移植功能障碍。这些感染的组织病理学特征表现为肾间质区域炎性细胞浸润，以及肾小管上皮细胞中出现病毒核内包涵体或细胞病变。通过免疫组织化学染色或使用电子显微镜检查观察病毒颗粒可确诊病原体。然而，与标准苏木精-伊红染色不同，这些方法通常需要更长的周转时间，且在发展中国家不易获得。值得注意的是，同种异体移植肾间质炎症的鉴别诊断几乎总是包括T细胞介导的排斥反应，其治疗方法与同种异体移植感染不同。本综述的目的是促使临床医生识别同种异体移植肾活检中观察到的各种病理改变，从而便于进一步调查及对疑似同种异体移植肾感染进行管理。
