case_images: PMC11175655_01
case_images: Timeline after kidney transplantation. CMV, cytomegalovirus.
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case_images: fig1
case_images: Subsequently, graft function slowly recovered allowing discontinuation of hemodialysis therapy on postoperative day 13 and stabilization of graft function at a serum creatinine level of 270 micromol/l corresponding to an estimated glomerular filtration rate (eGFR) of 26 mL/min/1.73 m2 according to chronic kidney disease epidemiology (CKD-EPI) formula (Figure 1). Due to this satisfying response to valganciclovir, MMF was maintained at the same dose of 2 g per day (Figure 1). Immunosuppressive therapy was maintained unchanged (Figure 1).
case_images: Immunosuppressive regimen and cyclosporin A trough levels after transplantation.
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case_images: fig2
case_images: Subsequently, the nephrostomy could be removed, and the serum creatinine remained stable at 193 mumoL/L (Figure 2).
case_images: Resected ureter segment. Narrowed lumen in transplant ureter due to the presence of a cellular proliferation (H&E, x 10).
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case_images: fig3
case_images: The histological examination of the resected transplant ureter showed presence of a PAX8-positive cell proliferation with surrounding fibrosis (Figure 3) consistent with nephrogenic adenoma.
case_images: Resected ureter segment. Microglandular proliferation of a nephrogenic adenoma with typical cytopathic appearance of a CMV-infected cell (H&E, x 200).
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case_images: fig4
case_images: Surprisingly, several cells showed cytopathic changes characteristic for CMV (Figure 4) and immunohistochemistry was positive for cytomegalovirus (CH2- and DDG-antibodies, Dako, dilution 1:400, pre-treatment H2 30 95; Figure 5).
case_images: Resected ureter segment. Cells within nephrogenic adenoma with positive immunohistochemic staining for CMV.
case_images: fmed-11-1394028-g005.jpg
case_images: PMC11175655_01_fmed-11-1394028-g005.jpg
case_images: fig5
case_images: Surprisingly, several cells showed cytopathic changes characteristic for CMV (Figure 4) and immunohistochemistry was positive for cytomegalovirus (CH2- and DDG-antibodies, Dako, dilution 1:400, pre-treatment H2 30 95; Figure 5).