title: Adenovirus nephritis in hematopoietic stem-cell transplantation.
abstract: BACKGROUND
  Although adenovirus (ADV) infections may involve many different organs, kidney infection is seldom reported in association with hematopoietic stem-cell transplantation (HSCT).
  
  
  METHODS
  In the present study, the diagnosis of ADV nephritis was established by the culture isolation of adenovirus or the immunocytochemical (ICC) demonstration of the adenoviral hexon protein. The clinical description of ADV nephritis was derived from retrospective review of clinical records to identify signs, symptoms, outcomes, and associated complications. ADV nephritis was characterized as a pathologic entity by the histologic and ICC analysis of tissue from the kidney and all other major organs to establish the distribution of the virus and the associated gross and microscopic alterations.
  
  
  RESULTS
  ADV nephritis was diagnosed in 21 HSCT patients, in 2 by biopsy and in 19 at autopsy. Focal signs of BK nephropathy were present in only one patient. Twenty had received allogeneic marrow and one had undergone autologous transplantation. Graft-versus-host disease was a risk factor. ADV nephritis was associated with acute renal failure in 90% of the infected patients. Prodromal symptoms included fever, hematuria, and flank pain. Adenoviruria was present in 78% of the patients. Kidney infection as determined by viral antigen ICC predominantly involved the tubular epithelial cells. ADV organ tropism was striking, with sero-types from subgenus B, cluster 2, primarily responsible for cases involving predominantly the urinary system. ADV infection was a major cause of death in 17 patients.
  
  
  CONCLUSIONS
  ADV nephritis is a specific renal complication in HSCT patients that can be diagnosed by renal biopsy in patients with hematuria and adenoviruria.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-4417, USA.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.forename: Richard A
authors.initials: RA
authors.lastname: Zager
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Boeckh
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Gooley
authors.forename: David H
authors.initials: DH
authors.lastname: Myerson
authors.forename: Meei-Li
authors.initials: ML
authors.lastname: Huang
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hackman
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D000257:Adenoviridae Infections / Q000209:etiology* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009393:Nephritis / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies