造血干细胞移植术后BK病毒肾病

BK virus nephropathy in a recipient with hematopoietic stem cell transplant

青年男性,因"急性淋巴细胞白血病"行造血干细胞移植,术后10d出现肠道移植物抗宿主病,术后6个月发现血象三系减低,肾脏表现为移植术后3个月及11个月两次血清肌酐升高,少量蛋白尿,无血尿,尿BK病毒高度复制,血BK病毒阴性。肾活检示肾小管间质病变,肾小管上皮细胞核内大量包涵体,免疫组化BK病毒大T抗原染色肾小管上皮细胞核阳性,最终诊断为BK病毒肾病。明确诊断后更改治疗方案为甲泼尼龙及西罗莫司,2个月后血清肌酐恢复正常。

A 31-year-old male presented with deterioration of renal function 11 months after having undergone allogeneic hematopoietic stem cell transplant（ allo-HSCT） for acute lymphoblastic leukemia. He had a mild proteinuria,without hematuria,BK viruria greater than 5 × 10-8 copies,and negative BK viremia. A renal biopsy demonstrated classical findings of BK virus nephropathy of severe tubulointerstitial injury,and many tubular intranuclear inclusions typical of BK polyoma virus,with immunostaining positive for BK virus large T-antigen. The diagnosis was BK virus nephropathy. The immunosuppressive drugs were changed to sirolimus and methylprednisolone. At the end of a 2 months follow-up,the patient＇s renal function gradually recovered.