Granulomatous tubulointerstitial nephritis in early renal allograft: a case report

Here we report a case of granulomatous tubulointerstitial nephritis occurring seven d after kidney transplantation. The development of macroscopic hematuria, acute prostatitis, a mild elevation of serum creatinine, and high-grade fever together with a urine culture positive for adenovirus antigen suggested adenovirus infection. Episode biopsy seven d after kidney transplantation showed granulomatous tubulointerstitial nephritis evidenced by predominantly CD68-positive cell infiltration and epithelioid cells at focal tubulointerstitial spaces with severe tubulitis, such as destruction of the tubular basement membrane. After intervention consisting of a reduction of the immunosuppressive therapy and administration of intravenous immunoglobulin (IVIG) and ganciclovir, renal function returned to normal, with a rapid recovery of the pathological as well as clinical features within a month. In renal allografts, adenovirus infection should be considered during the early phase following transplantation, even within seven d, especially when granulomatous tubulointerstitial nephritis is present.