Tomoe H, Onitsuka S, Nishino S, Suzuki M, Yago R, Goya N, Toma H
Department of Urology, Tokyo Women's Medical College.
Hinyokika Kiyo. 1994 Nov;40(11):1005-8.
A 16-year-old female received a kidney transplantation from her mother 13 months before she suddenly noticed gross hematuria and painful micturition, and developed high fever with chills. The serum creatinine (S-Cr) level rose from 1.5 to 2.6 mg/dl, but there was no clinical sign of acute rejection. Despite the treatment with antibiotics and gamma-globulin, the the high fever and hematuria did not improve. The adenovirus antibody titer elevated from x8 to x1,024, while adenovirus was not isolated from the urine. On the 15th day of the disease, hematuria disappeared spontaneously and on the 19th day she became afebrile. The S-Cr level also was normalized spontaneously. Histological examination of the graft biopsy on the 14th day, showed severe tubulointerstitial nephritis localized in the renal medulla and full type intranuclear inclusions were revealed in tubular epithelial cells. From these findings, we diagnosed this case as adenovirus-induced kidney graft pyelonephritis associated with acute hemorrhagic cystitis.
一名16岁女性在接受其母亲的肾移植13个月后，突然出现肉眼血尿、排尿疼痛，并伴有高热寒战。血清肌酐（S-Cr）水平从1.5mg/dl升至2.6mg/dl，但无急性排斥反应的临床体征。尽管使用了抗生素和丙种球蛋白治疗，高热和血尿仍未改善。腺病毒抗体滴度从x8升至x1024，而尿液中未分离出腺病毒。病程第15天，血尿自行消失，第19天体温恢复正常。S-Cr水平也自行恢复正常。病程第14天移植肾活检的组织学检查显示，严重的肾小管间质性肾炎局限于肾髓质，肾小管上皮细胞内可见完整型核内包涵体。根据这些发现，我们将该病例诊断为腺病毒引起的肾移植肾盂肾炎合并急性出血性膀胱炎。
