Abstract: SA-PO1142
Navigating Uncertain Waters: Treatment of Adenovirus Nephropathy in Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Kofahi, Dena, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Stevens, Trevor C., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Schaefer, Heidi M., Vanderbilt University Medical Center, Nashville, Tennessee, United States
Introduction
Adenovirus is a DNA virus that can cause severe infections in kidney transplant recipients, classically causing hemorrhagic cystitis and tubulointerstitial nephritis. We herein discuss a case of a 67-year-old male who presented with hematuria and acute kidney dysfunction due to suspected adenovirus nephropathy.
Case Description
A 67-year-old male with medical history notable for end stage kidney disease secondary to hypertension and chemotherapy induced nephritis status post kidney transplant on tacrolimus and prednisone presented with fever and gross hematuria. He had a creatinine of 4.94mg/dL from a baseline of 2.0mg/dL and a urinalysis with elevated white blood cells, red blood cells, and protein. Urine culture was negative. Renal transplant ultrasound revealed pelviectasis with urothelial thickening and internal debris within the collecting system. Respiratory viral panel and urine PCR were positive for adenovirus. A plasma PCR showed an adenovirus load of 3.5 million IU/mL. He received a dose of intravesicular cidofovir, but his creatinine continued to worsen with a peak of 8.89. He was then given two doses of intravenous cidofovir, spaced a week apart, with probenecid. The patient had substantial improvement in symptoms with creatinine returning to his baseline of 2.0 mg/dL. He had clearance of adenovirus in his plasma in 8 weeks.
Discussion
Adenovirus nephropathy in kidney transplant recipients is relatively uncommon. There are no randomized clinical trials to provide clear treatment guidelines on immunosuppression modification and cidofovir use. Immunosuppression reduction is often the first course of treatment, though there is no evidence to support which agents to reduce. This patient was on tacrolimus and prednisone, with his mycophenolate mofetil already held due to prior CMV infection. If adenovirus infection does not respond to immunosuppression reduction, cidofovir is the first-line agent used based on case series and institutional precedents. Its use is limited due to toxic effects on renal proximal tubular epithelial cells. Probenecid is given to mitigate this by reducing the tubular uptake of cidofovir. One should have a high suspicion for adenovirus infection in kidney transplant recipients presenting with bacterial culture negative UTI with dysuria, hematuria, and acute kidney dysfunction.