Background: Previous studies have examined the specific entities of renal pathology with bacterial/viral diseases. Few have broadly studied infectious disease relevance in patients affected by current immunosuppressive and cytotoxic regimens. This retrospective was performed on patients who had renal biopsy to assess renal dysfunctions. Methods: Twenty transplant/non-transplant renal biopsies performed between January 1, 2009 and November 30, 2009 were randomly reviewed. Concurrent infectious diseases were identified. Results: The biopsies belonged to 13 males & 6 females (7 cases: native biopsies & 13 cases: transplant biopsies). Of the transplant cases, 4 cases showed concurrent infectious diseases (23%). These cases included 2 cases (15%) from 1 patient with recurrent polyoma nephropathy, 2 cases (15%) with chronic allograft nephropathy (including 1 case with pyelonephritis/reflux nephropathy & 1 case with HIV having acute tubular injury). The others, with no infectious complications, included 5 cases (38%) with delayed graft functions, 1 case (8%) with severe transplant glomerulopathy, and 1 case (8%) with chronic allograft nephropathy/recurrence of focal proliferative lupus nephropathy. Of the native renal cases, 2 cases (29%) were identified with infectious complication. The cases include 1 case (14%) with HIV/HCV (& hypertension/chronic kidney disease/recurrent bacterial pneumonia) and 1 case with urethral stenosis and chronic pyelonephritis. The remaining cases without infections include recurrent focal segmental glomerulosclerosis (FSGS), 1 case (14%) with membranous lupus nephropathy, 1 case (14%) with focal proliferative nephritis & Henoch-Schonlein Purpura (HSP), 1 case with minimal change (14%) in complete remission, and 1 hypertensive nephropathy case with thrombotic microangiopathy (TMA). With current immunosuppressive/cytotoxic drug regimen and careful follow up, few patients demonstrate concurrent infectious disease. The few affected patients have history of urinary tract infections associated urinary tract reflux/obstruction. Recurrent polyoma viral nephropathy, seen in 2 cases of a pediatric patient, needed decreased immunosuppressive regimen, altered cytotoxic therapy, and antiviral medication. One native kidney case of a patient with HIV/Hepatitis C infection showed recurrent pneumonia. Conclusion: In this small review, most native & all recently transplanted specimens (within several months) did not show systemic infections despite heavy initial dose of cytotoxic/immunosuppressive regimen. Few affected cases showed underlying chronic conditions such as HIV or obstructive/reflux uropathy. Current regimens and clinical management of medical renal diseases/renal transplants appear adequate & effective without risking the patient to unnecessary infections.
Nguyen, C. (2010). Relevance of infectious diseases in nephrology patients: A retrospective single center Review of twenty renal biopsies. International Journal of Infectious Diseases, 14, e287–e288. https://doi.org/10.1016/j.ijid.2010.02.2123