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- 移植肾穿刺病例
The photo 4 and 5 show tubulitis without obvious viral inclusions, raising the possibility of concurrent Banff type 1 rejection. Here is the guideline to differentiate BK virus induced tubulitis from rejection related tubulitis.
"Polyomavirus nephropathy (PVN) and rejection (acute, chronic, cell and/or antibody mediated) can concur and should be diagnosed according to standard criteria. Suggest concurrent Banff type I cellular tubulo-interstitial rejection if inflammation and tubulitis are seen in areas distant from viral replication, i.e. SV40 positive nuclei (by IHC) are more than one 20 x field away from foci with inflammation and tubulitis."
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本帖最后由 于 2010-01-21 19:17:00 编辑
| 以下是引用quhong在2010-1-21 1:18:00的发言：
The photo 4 and 5 show tubulitis without obvious viral inclusions, raising the possibility of concurrent Banff type 1 rejection. Here is the guideline to differentiate BK virus induced tubulitis from rejection related tubulitis. "Polyomavirus nephropathy (PVN) and rejection (acute, chronic, cell and/or antibody mediated) can concur and should be diagnosed according to standard criteria. Suggest concurrent Banff type I cellular tubulo-interstitial rejection if inflammation and tubulitis are seen in areas distant from viral replication, i.e. SV40 positive nuclei (by IHC) are more than one 20 x field away from foci with inflammation and tubulitis." |
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There are two reasons I don't favor CMV infection: 1) CMV is not seen in transplant kidney for the last ten years, at least in my hosptial; 2) CMV and BK may be overlaping morphologically. In the above case, there is no halo around the inclusions. If you don't have CMV antibody, you may just try SV-40 to rule out or rule in BK virus infection. If SV40 stain is negative, it could be CMV infection.
