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Currently filtering by tag: Viral cytopathic changes

Adenovirus

This allograft biopsy shows the characteristic features of adenovirus infection. There is prominent interstitial hemorrhage and edema (Fig. 1), acute tubular injury with viral cytopathic effect and positive immunohistochemical cytoplasmic and nuclear staining for adenoviral antigen (Fig. 2), and foci of tubular necrosis (Fig. 3). The differential diagnosis for this morphology in the transplant setting includes other viral infection (e.g. polyomavirus, CMV, HSV), acute rejection, and drug-related acute interstitial nephritis.

Diagnose This! (February 26, 2018)

What is your diagnosis of this renal transplant patient?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​...

Diagnose This! (October 2, 2017)

What is your diagnosis in this renal allograft biopsy?     ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​    ...

BK Nephritis

This biopsy is from a patient with ESRD due to polycystic kidney disease. He is s/p deceased donor renal transplant 11 months prior to this biopsy. He was noted to have a steadily rising creatinine from baseline of 1.3 mg/dl up to 4.6 mg/dl at biopsy. Note the severe interstitial inflammation with nuclear atypia and severe arteriosclerosis (Figure 1, H&E 100x). There are markedly atypical nuclei including an apoptotic body (arrowhead) seen in the second image (Figure 2, 400x). The third image shows an SV40 IHC stain for polyoma virus that is positive in many nuclei (Figure 3, IHC SV40...

Cytomegalovirus

The biopsy from this adult kidney transplant recipient shows features of cytomegalovirus (CMV) infection, including prominent enlargement (“cytomegalo-”) of tubular epithelial cells and their nuclei, along with small basophilic inclusions which expand the cell cytoplasm. An immunostain for CMV was also positive for viral antigen. In the kidneys, CMV shows tropism for tubular epithelial and glomerular endothelial cells. The gold standard for the diagnosis of tissue-invasive CMV disease remains the histopathologic identification of the characteristic cytoplasmic and/or nuclear viral inclusions or positive immunohistochemical detection of CMV viral antigens in tissue. Active CMV disease may be donor-derived (iatrogenic) or it may...

Pushing Glass (May 30, 2017)

A 62-year-old Asian male with a past medical history significant for ESRD secondary to hypertension S/P renal transplant (9 months ago) presents with a creatinine of 1.9 (baseline 1.2). The patient has had no previous episodes of rejection. The donor-specific antibody is negative. CMV, adenovirus and BK serology is pending. What is the best diagnosis? A. Acute Cellular Rejection, Banff Type 1B B. BK Nephritis C. Adenovirus D. Acute Antibody-Mediated Rejection The correct answer is B (BK nephritis). The low power trichrome picture shows patchy interstitial inflammation and fibrosis. The glomerulus has thickened capillary walls, but no definitive double contours...