Adenovirus Interstitial Nephritis post-Kidney Transplant: Case Series and Literature Review.

Abstract

Background: Post-kidney transplant adenovirus nephritis is a condition with potential for acute allograft dysfunction, and evidence on its management is scarce.

Methods: The present study is an original case series based on kidney biopsy of seven patients obtained at a health center specialized in kidney pathology from 2009 to 2023. We also performed a non-systematic literature review on cases described in the literature.

Results: Kidney biopsy was used to define the diagnosis of all patients. The average time to diagnosis after transplantation was 32.9 months. The most prevalent symptoms were fever, macroscopic hematuria, and dysuria. The glomerular filtration rate (GFR) reduced on average four times in relation to the baseline GFR. The main findings of kidney biopsy were acute tubular necrosis (100%), necrotizing granulomatous interstitial nephritis (100%) and viral inclusions (100%). The therapies used were human immunoglobulins, antivirals, and reduction of immunosuppression. The clinical course was favorable in six of the seven patients. Our literature review found 44 cases of adenovirus interstitial nephritis, and the outcome was favorable in the majority of reported cases.

Conclusions: Adenovirus interstitial nephritis is a rare condition, but with important implications for kidney transplant recipients. Kidney biopsy plays a very important role in confirmation. This study fills gaps in the current literature on adenovirus interstitial nephritis and contributes to the understanding of this potential complication in the follow-up of kidney transplant recipients.