Castro L A, Gokel J M, Thoenes G, Frösner G, Land W, Hillebrand G, Gurland H J
Proc Eur Dial Transplant Assoc. 1983;19:500-4.
Renal biopsy was performed in 20 graft recipients to characterise the histological features associated with poor renal function concomitant with cytomegalovirus infection (CMV). Eight patients presented with proteinuria, three had microscopic haematuria at onset, and five were hypertensive. Infection was accompanied by clinical symptoms (fever, leucopenia, mild hepatic damage, or pneumonitis) in 15 patients. In all cases, serum creatinine was greater than 2 mg/dl. All patients showed some glomerular alteration on biopsy, and vascular changes were the predominant feature in seven cases. IgM and complement (C3) were found in the glomeruli of five of six patients studied by immunofluorescence. Serum creatinine was below 2 mg/dl at ten to 26 months following the infectious episode in four patients and between 2-3 mg/dl in three patients. The remaining 13 developed irreversible rejection and end-stage renal failure. We conclude that CMV, the most commonly recognised viral infection following transplantation, can cause renal changes, both glomerular (CMV glomerulopathy) and vascular (transplant vasculopathy), which may induce poor graft function.
对20例肾移植受者进行了肾活检，以明确与巨细胞病毒（CMV）感染相关的肾功能不佳的组织学特征。8例患者出现蛋白尿，3例起病时出现镜下血尿，5例为高血压患者。15例患者感染伴有临床症状（发热、白细胞减少、轻度肝损伤或肺炎）。所有病例血清肌酐均大于2mg/dl。所有患者活检均显示有一些肾小球改变，7例以血管改变为主要特征。6例接受免疫荧光检查的患者中有5例在肾小球中发现IgM和补体（C3）。4例患者在感染发作后10至26个月血清肌酐低于2mg/dl，3例患者血清肌酐在2至3mg/dl之间。其余13例发生不可逆排斥反应和终末期肾衰竭。我们得出结论，CMV是移植后最常见的病毒感染，可引起肾脏改变，包括肾小球（CMV肾小球病）和血管（移植血管病）改变，这可能导致移植肾功能不佳。
