A promoting role for rejection appears likely, because Polyomavirus interstitial nephritis is quite uncommon in recipients of heart, liver, or lung transplants. Alternatively, the allograft kidney may serve as a "sanctuary" for the virus, since T-cell killing of virally infected cells requires self-major

Figure 21.6. Polyomavirus interstitial nephritis. Electron microscopy reveals the 30- to 40-nm viral particles in tubular nuclei (bar = 100 nm).

histocompatibility complex (MHC) antigens to be expressed on the target cells. Most recent cases have arisen in patients on tacrolimus or mycophe-nolate mofetil (MMF). Among centers using tacrolimus and MMF, the frequency of polyoma associated interstitial nephritis (AIN) is 3% to 5% (15-18). Recovery, without reduction of immunosuppression is not common (69% graft loss). With reduction of immunosuppression, graft survival is likely (>95%), but functional recovery is poor (38% have residual Cr >3.0 mg/dL) (15,17,19,20). Protocol biopsies and monitoring of blood/urine for virus should permit earlier treatment and improved outcome. The use of polymerase chain reaction (PCR) to detect viral DNA in the circulation has been reported to distinguish those with interstitial nephritis from non-invasive urothelial shedding of the virus (21). Antivirals, such as cidofovir, have had limited success.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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