C4d 강 양성을 보인 BK 바이러스 신병증 1예

Title
C4d 강 양성을 보인 BK 바이러스 신병증 1예
Other Titles
A Case of BK Virus Nephropathy with Strong C4d Deposition in a Renal Allograft Recipient
Author(s)
이은영[이은영]박선희[박선희]최지영[최지영]조지형[조지형]김찬덕[김찬덕]김용림[김용림]김용진
Keywords
Renal transplantation; BK virus; Complement C4d; Renal transplantation; BK virus; Complement C4d
Issue Date
201003
Publisher
대한신장학회
Citation
Kidney Research and Clinical Practice, v.29, no.2, pp.285 - 291
Abstract
C4d deposition in peritubular capillaries in renal allograft biopsies is a significant marker for diagnosis of antibody-mediated rejection. However, it is unclear whether C4d deposition could be derived from BK virus infection. We present a case of BK virus nephropathy with strong C4d deposition 10 months after kidney transplantation. The diagnosis of BK virus nephropathy was missed out, whereas strong C4d deposition was noted in the first biopsy and therefore anti-rejection therapy was started. The deterioration of renal function led to a evaluate the possibility of BK virus nephropathy with second graft biopsy and further studies of BK virus replication status. Second graft biopsy revealed BK virus nephropathy without rejection. Finally, discontinuation of immunosuppressants and addition of anti-viral therapy for BK virus resulted in recovery of renal function, despite development of pancytopenia and subsequent fungal infection after leflunomide therapy. As in this case, initial focal pathologic changes from BK virus nephropathy could be overlooked by light microscopy. In addition, even though C4d positivity in peritubular capillaries is a good marker for diagnosis of antibody-mediated rejection, the meticulous examinations of the localization of C4d is needed, considering BK virus activates complement pathways and therefore leads to deposition of C4d mainly in tubular basement membrane. Based on our case of BK virus nephropathy with strong C4d deposition, we suggest that C4d deposition could be derived from BK virus nephropathy and therefore, it should be differentiated from acute antibody- mediated rejection in a renal allograft recipient.
URI
http://hdl.handle.net/YU.REPOSITORY/22722
ISSN
2211-9132
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의과대학 > 병리학교실 > Articles
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