title: Clinical characteristics and outcomes of adenovirus infection of the urinary tract after renal transplantation.
abstract: BACKGROUND
  Urinary tract infection caused by human adenovirus (HAdV) after renal transplantation (RT) results in graft loss because of concomitant nephropathy and acute rejection and may result in death because of systemic dissemination.
  
  
  METHODS
  We assessed the time period between RT and disease onset, symptoms, treatment details, disease duration, renal graft function, outcomes, and complications.
  
  
  RESULTS
  HAdV infection of the urinary tract occurred in 8 of 170 renal transplant recipients. Symptoms were macrohematuria in all 8 patients, dysuria in 7, and fever in 5. The median period from RT to disease onset was 367 (range, 7-1763) days, and the median disease duration was 15 (range, 8-42) days. The mean serum creatinine (sCr) level prior to onset was 1.35 ± 0.48 mg/dL and the mean maximum sCr level during disease was 2.34 ± 1.95 mg/dL. These values were increased by ≥25% in 5 patients. The mean sCr levels when symptoms resolved was 1.54 ± 0.67 mg/dL, and no significant difference was seen before, during, or after disease onset (P = 0.069). Two patients were diagnosed with HAdV viremia and 1 with acute tubulointerstitial nephritis revealed on biopsy. In addition to a reduction in immunosuppressant dosage, 2 patients received gammaglobulins and 5 received ganciclovir.
  
  
  CONCLUSIONS
  Symptoms of all patients were alleviated, although some patients developed nephritis or viremia. Hence, the possibility of exacerbation should always be considered. Adequate follow-up observation should be conducted, and diligent and aggressive therapeutic intervention is required to prevent the condition from worsening.
authors.affiliation: Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Nanmoku
authors.affiliation: Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Ishikawa
authors.affiliation: Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Kurosawa
authors.affiliation: Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Miki
authors.affiliation: Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sakuma
authors.affiliation: Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yagisawa
mesh_terms: D000258:Adenovirus Infections, Human / Q000150:complications* / Q000821:virology*; D000260:Adenoviruses, Human / Q000302:isolation & purification*; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use; D006084:Graft Rejection; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D014552:Urinary Tract Infections / Q000150:complications / Q000821:virology*
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D015774:Ganciclovir
keywords: acute tubulointerstitial nephritis; ganciclovir; human adenovirus; renal transplantation; urinary tract infection