Tubular basement membrane immune deposits in association with BK polyomavirus nephropathy

被引:30
作者
Bracamonte, E.
Leca, N.
Smith, K. D.
Nicosia, R. F.
Nickeleit, V.
Kendrick, E.
Furmanczyk, P. S.
Davis, C. L.
Alpers, C. E.
Kowalewska, J. [1 ]
机构
[1] Univ Washington, Dept Pathol, Seattle, WA 98195 USA
[2] Univ Washington, Dept Med, Seattle, WA 98195 USA
[3] Univ Washington, Div Nephrol, Seattle, WA 98195 USA
[4] Univ N Carolina, Dept Pathol, Chapel Hill, NC USA
关键词
allograft; BK polyomavirus; histology; kidney; nephropathy; tubular basement membrane; immune deposits;
D O I
10.1111/j.1600-6143.2007.01794.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Tubular basement membrane immune deposits (TBMID) are rare in renal allografts and usually have been found in association with immune complex mediated glomerular injury. We report an association between TBMID and BK polyomavirus nephropathy (BKN). We reviewed clinical data and results of allograft biopsies of 30 patients with BKN (16 with and 14 without TBMID). TBMID were detected by immunofluorescence or electron microscopy. Initial and follow-up biopsies were assessed for degree of interstitial inflammation and fibrosis and severity of viral infection, and were correlated with patients' clinical data. Biopsies initially diagnostic for BKN with TBMID, compared to BKN biopsies without deposits, demonstrated more severe interstitial inflammation and fibrosis, and greater numbers of virally infected cells. Similar findings were present in follow-up biopsies. Utilizing three different antibodies directed against viral epitopes, viral antigens could not be detected within TBMID. Thirty percent of patients with TBMID and 70% without deposits had follow-up biopsies, in which virus could not be detected immunohistochemically. Treatment for all included decreasing immunosuppression, cidofovir and/or leflunomide. Clinical data correlated well with histological findings. We conclude that a significant proportion of patients with BKN show TBMID on kidney biopsy. The prognostic significance of this finding remains to be elucidated.
引用
收藏
页码:1552 / 1560
页数:9
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