CMV and BKV ureteritis: which prognosis for the renal graft?
This report describes two cases of ureteral stricture in renal graft recipients related to cytomegalovirus (CMV) and human polyoma BK virus (BKV) ureteritis with the same onset characterized by acute graft failure with no clinical signs of systemic viral infections. The histological analysis did not show other causes of graft impairment (i.e. drug toxicity and acute rejection). Ultrasound scan (US) revealed absent or mild hydronephrosis. The diuretic-MAG3 renal scan showed a urinary flow obstruction. The viral genomes were isolated from urine, peripheral blood and graft or ureteral tissues samples. A percutaneous nephrostomy confirmed the stricture, but it restored urine flow only in the graft affected by CMV ureteritis, the association with a specific antiviral therapy probably produced a stable restoration of graft function. In BKV ureteritis,the graft prognosis was poor; graft loss could be due to the progress of BKV nephropathy. A correct differential diagnosis of the etiologic agent responsible for the ureteritis is mandatory, because treatment and outcome of the infection are different.
Fusaro
Fabio
F
Department of Pediatrics and Pediatric Surgery, University of Padova, Padua, Italy. fabiofusaro@libero.it
Murer
Luisa
L
Busolo
Franco
F
Rigamonti
Waifro
W
Zanon
Giovanni F
GF
Zacchello
Graziella
G
D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use*; D001739:BK Virus / Q000187:drug effects / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000188:drug therapy*; D011183:Postoperative Complications / Q000188:drug therapy / Q000821:virology; D012086:Reoperation; D018570:Risk Assessment; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000188:drug therapy*; D014515:Ureteral Diseases / Q000188:drug therapy* / Q000821:virology
D000998:Antiviral Agents