Adenovirus infection in the renal allograft is very rare, but usually occurs early after transplant (first 3 months). Clinically significant adenovirus infection typically involves the urothelium and causes hemorrhagic cystitis, primarily in immunosuppressed patients. Hematuria is a common presenting symptom. Serotype 11 is most often associated with clinical disease.
The histology is characterized by intranuclear viral inclusions in the tubular epithelial cells, severe tubular destruction with necrosis, marked interstitial granulomatous inflammation, and focal interstitial hemorrhage +/- RBC casts.
Treatment for adenovirus nephritis is not well defined. Different strategies have involved IVIG, decreased immunosuppression, and anti-viral agents.
Despite a lack of standardized treatment, the prognosis is good with graft loss rare.