Case 12: Pathology

Case 12 Index

Excellent work, your patient tolerated the kidney biopsy well. It’s the day afterwards and your pathologist shows you the H&E stain  Click here if you want some quick pathology tips.

Adenovirus Induced Acute Interstitial Nephritis in a Renal Transplant, H&E StainAdenovirus Induced Acute Interstitial Nephritis with Inclusions in a Renal Transplant, H&E Stain

Your pathologist tells you that the SV40 (Simian Virus 40)  stain was negative, but another immunohistochemistry (IHC) stain was positive:

Adenovirus IHC Stain with Positive Staining in Tubular Epithelial Cells

Which of the following tests below will help you clinch this diagnosis?
Serum and urine BK PCR
The negative SV40 stain makes BK nephropathy unlikely. Try again!
Serum and urine adenovirus PCR
Excellent choice, you find numerous copies of adenovirus in both the serum and the urine! Click below to move on!
Urine eosinophils
Though there is significant interstitial inflammation, urine eosinophils are not a sensitive or specific test for acute interstitial nephritis (AIN) . Further, there are clues in the biopsy that make AIN less likely.
It’s time to lock in your final diagnosis! Choose one below:
Pre-renal acute kidney injury
Obstructive nephropathy
Acute interstitial nephritis
Adenovirus nephropathy
BK nephropathy
Acute cellular rejection
Antibody mediated rejection
Bladder cancer
Renal cell carcinoma
Urinary tract infection
IgA nephropathy
Membranous nephropathy

Click here to wrap up this case!

Case 12 Index
Case 12 Introduction
Case 12 Physical Exam

Case 12 Diagnostic Testing