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Is cytomegalovirus associated with renal disease in AIDS patients?
T Nadasdy1, K W Miller, L D Johnson
1Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City.
Abstract:
Although it has been suggested that cytomegalovirus (CMV) infection of the kidney might facilitate the development of human immunodeficiency virus-associated nephropathy (HIVAN) or other morphologic renal changes in patients with AIDS, no systematic study has been performed on kidneys from AIDS patients. We examined 75 autopsy kidneys, two renal biopsy specimens, and a nephrectomy specimen from 78 HIV-infected patients (five with HIVAN) for the presence of CMV. Immunocytochemistry (ICC) utilizing a monoclonal antibody against the late antigen of CMV and in situ hybridization (ISH) with a biotinylated DNA probe for CMV sequences were used. The detection system for both ICC and ISH was streptavidin-conjugated alkaline phosphatase with Fast Red TR chromogen. CMV was detected in only 10 of the 78 kidneys examined (12.8%): eight by both methods, one by ISH only, and another by ICC only. All 10 positive kidneys were obtained from autopsies of patients with AIDS. The average number of positive cells (in approximately 15 x 10 mm sections) was 22 with ICC and 10 with ISH. Glomerular intracapillary cells (possibly endothelial cells) were the most commonly stained, followed by positive cells in the interstitium and peritubular capillaries. Relatively few tubular epithelial cells were stained. The majority of positive cells by either ICC or ISH did not show nuclear or cytoplasmic inclusions; however, only two of the 10 positive kidneys did not contain cells with typical Cowdry type-A intranuclear CMV inclusions. The most frequent pathologic finding in the kidneys positive for CMV by either ICC or ISH was acute tubular necrosis (in six of 10, 60%).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Cytomegalovirus (CMV) was detected in only 12.8% of kidneys from HIV-infected patients, primarily in those with AIDS. CMV infection in these kidneys was most frequently associated with acute tubular necrosis.
Area of Science:
- Nephrology
- Virology
- Pathology
Background:
- Cytomegalovirus (CMV) infection has been hypothesized to contribute to kidney damage in patients with Acquired Immunodeficiency Syndrome (AIDS).
- Previous research lacked systematic investigation into the prevalence and impact of CMV in the kidneys of individuals with HIV/AIDS.
Purpose of the Study:
- To systematically investigate the presence and localization of Cytomegalovirus (CMV) in renal tissues from human immunodeficiency virus (HIV)-infected patients.
- To determine the association between CMV detection and specific renal pathologies, including HIV-associated nephropathy (HIVAN).
Main Methods:
- Examination of 78 renal specimens (75 autopsy kidneys, 2 biopsy, 1 nephrectomy) from HIV-infected individuals.
- Utilized immunocytochemistry (ICC) and in situ hybridization (ISH) for CMV detection.
- Employed streptavidin-conjugated alkaline phosphatase with Fast Red TR chromogen as the detection system.
Main Results:
- CMV was detected in 10 out of 78 kidneys (12.8%), exclusively in patients with AIDS.
- Positive staining for CMV was most common in glomerular intracapillary cells, followed by interstitial and peritubular capillary cells.
- Acute tubular necrosis was the most frequent pathological finding in CMV-positive kidneys (60%).
Conclusions:
- CMV infection is present in a minority of HIV-infected individuals' kidneys, predominantly those with AIDS.
- CMV detection in renal tissue, even without typical inclusions, can be associated with significant pathology like acute tubular necrosis.
- Further research is warranted to elucidate the precise role of CMV in HIV-associated kidney disease.