51. Clinicopathologic Characteristics of JC Virus Nephropathy in Kidney Transplant Recipients.
- Author
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Wiegley N, Walavalkar V, Aujla H, Chen LX, Huang Y, Lee BK, and Jen KY
- Subjects
- Adult, Aged, Biopsy, California, Female, Fibrosis, Host-Pathogen Interactions, Humans, Immunocompromised Host, Immunosuppressive Agents adverse effects, JC Virus immunology, Kidney immunology, Kidney pathology, Kidney Diseases diagnosis, Kidney Diseases immunology, Male, Middle Aged, Polyomavirus Infections diagnosis, Polyomavirus Infections immunology, Time Factors, Treatment Outcome, Tumor Virus Infections diagnosis, Tumor Virus Infections immunology, Viral Load, JC Virus pathogenicity, Kidney virology, Kidney Diseases virology, Kidney Transplantation adverse effects, Polyomavirus Infections virology, Tumor Virus Infections virology, Virus Activation
- Abstract
Background: The vast majority of polyomavirus nephropathy (PVN) is due to BK virus, but rare cases result from JC virus reactivation. To date, only a handful of biopsy-proven JC-PVN cases have been reported. Here, we describe the clinical and pathologic findings in 7 patients with biopsy-proven JC-PVN., Methods: Search of the pathology archives at 2 institutions found 7 cases of JC-PVN. Clinical data were extracted from the electronic medical records, and the biopsies were reviewed., Results: Four cases were diagnosed at 6 y posttransplant or later. The remaining 3 cases presented within approximately 2 y posttransplant, of which 2 showed subclinical JC-PVN on surveillance biopsy. Two early presenting patients were treated for acute rejection just before acquiring JC-PVN. Late presenting patients had higher chronicity, which correlated to worse outcome. All but 1 biopsy showed nonspecific inflammation within areas of interstitial fibrosis without significant inflammation in unscarred cortex. The earliest presenting patient was the exception and showed active inflammation with tubulitis. Viral cytopathic changes were detected in all cases with moderate or high-histologic viral load (pvl), showing preference for the distal tubules and medulla. The 2 cases with low pvl did not demonstrate cytopathic changes but were SV40 positive., Conclusions: JC-PVN can be insidious in presentation, which may cause delayed or missed diagnosis. Unlike BK-PVN, which typically occurs early in the posttransplant period, JC-PVN can occur both early and late following transplant. Overreliance on negative plasma and urine BK viral loads to exclude PVN can be a pitfall., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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