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Granulomatous inflammation in BK polyomavirus–associated nephropathy
Author(s) -
Zhang Yang,
Ahmed Hiba,
Haririan Abdolreza,
Ugarte Richard,
Papadimitriou John C.,
Drachenberg Cinthia B.
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12939
Subject(s) - medicine , inflammation , nephropathy , immunology , bk virus , polyomavirus infections , virology , endocrinology , diabetes mellitus
Evolving BK polyomavirus–associated nephropathy ( BKP y VAN ) is characterized by tubulointerstitial inflammation that closely resembles acute T‐cell–mediated allograft rejection if tubulitis is significant. The cellular composition of the inflammation varies during the course of BKP y VAN , and clusters of plasma cells may herald resolution of the infection. Less commonly, BKP y VAN can present with a predominance of histiocytes and granuloma formation. Granulomatous interstitial nephritis is uncommon in biopsies of either native or transplant kidneys. In both settings, this distinctive type of inflammatory response requires a systematic approach with careful clinicopathological assessment to determine its etiology. We present three patients with granulomatous BKP y VAN in the first year post‐transplantation. These allograft biopsies at 4, 6, and 12 months post‐transplant exemplify spontaneously resolving BKP y VAN , resolving infection after immunosuppression reduction, and early BKP y VAN , respectively. In immunosuppressed patients, BKP y VAN should be added to the relatively broad differential diagnosis of granulomatous tubulointerstitial nephritis.