Transplantation proceedings · 2025
Transplant Ureteral Stenosis Caused by Polyomavirus Ureteritis in Allograft Kidney Transplantation: Two Cases Report and a Literature Review.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
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Zhang Tianlu, Wu Qinyun, Shen Rongfang, Peng Wenhan, Jin Zhenpeng, Luo Sulin, Guo Luying, Wang Meifang, Wu Jianyong, Chen Jianghua, Wang Rending
Аннотация
BACKGROUND: Polyomavirus ureteritis is a rare but increasingly recognized complication in kidney transplantation, with the potential to cause ureteral stenosis and graft loss. We report two pathologically confirmed cases of polyomavirus ureteritis presenting as ureteral stenosis, successfully treated with ureterovesical reimplantation surgery and adjustments in immunosuppressive therapy.
CASE PRESENTATION: The first case describes a 41-year-old male renal transplant recipient, who presented with progressive hydronephrosis and an elevated serum creatinine (Scr) level of 308 μmol/L 5 months post-transplant. The second case involves a 25-year-old female recipient who developed hydronephrosis and dilatation of the upper ureter in the transplanted kidney 2 months post-transplant, with a subsequent rise in Scr level to 167 μmol/L. Urine tests revealed high polyomavirus loads, while blood viremia tests remained negative. Ureteral biopsy confirmed polyomavirus ureteritis through simian virus 40 immunohistochemical staining. Following successful ureterovesical reimplantation surgery and tailored reduction in immunosuppressive regimens, both patients cleared the virus in urine and their Scr levels returned to baseline.
CONCLUSION: This report highlights ureteral polyomavirus infection as a critical differential diagnosis in cases of ureteral stenosis among kidney transplant recipients. Accurate diagnosis requires thorough pathological evaluation, including simian virus 40 staining of ureteral tissue. Early recognition and individualized therapeutic strategies are essential to preserve graft function and improve patient outcomes.
CASE PRESENTATION: The first case describes a 41-year-old male renal transplant recipient, who presented with progressive hydronephrosis and an elevated serum creatinine (Scr) level of 308 μmol/L 5 months post-transplant. The second case involves a 25-year-old female recipient who developed hydronephrosis and dilatation of the upper ureter in the transplanted kidney 2 months post-transplant, with a subsequent rise in Scr level to 167 μmol/L. Urine tests revealed high polyomavirus loads, while blood viremia tests remained negative. Ureteral biopsy confirmed polyomavirus ureteritis through simian virus 40 immunohistochemical staining. Following successful ureterovesical reimplantation surgery and tailored reduction in immunosuppressive regimens, both patients cleared the virus in urine and their Scr levels returned to baseline.
CONCLUSION: This report highlights ureteral polyomavirus infection as a critical differential diagnosis in cases of ureteral stenosis among kidney transplant recipients. Accurate diagnosis requires thorough pathological evaluation, including simian virus 40 staining of ureteral tissue. Early recognition and individualized therapeutic strategies are essential to preserve graft function and improve patient outcomes.