Supplemental Material: Kidney biopsy findings from a series of seven cases of adenovirus nephritis after kidney transplantation.

Background: Post-kidney transplant adenovirus nephritis is a condition with potential for acute allograft dysfunction, and evidence on its management is scarce. Methods: The present study is an original case series based on kidney biopsy of seven patients obtained at a health center specialized in kidney pathology from 2009 to 2023. We also performed a non-systematic literature review on cases described in the literature. Results: Kidney biopsy was used to define the diagnosis of all patients. The average time to diagnosis after transplantation was 32.9 months. The most prevalent symptoms were fever, macroscopic hematuria, and dysuria. The glomerular filtration rate (GFR) reduced on average four times in relation to the baseline GFR. The main findings of kidney biopsy were acute tubular necrosis (100%), necrotizing granulomatous interstitial nephritis (100%) and viral inclusions (100%). The therapies used were human immunoglobulins, antivirals, and reduction of immunosuppression. The clinical course was favorable in six of the seven patients. Our literature review found 44 cases of adenovirus interstitial nephritis, and the outcome was favorable in the majority of reported cases. Conclusion: Adenovirus interstitial nephritis is a rare condition, but with important implications for kidney transplant recipients. Kidney biopsy plays a very important role in confirmation. This study fills gaps in the current literature on adenovirus interstitial nephritis and contributes to the understanding of this potential complication in the follow-up of kidney transplant recipients.

背景：肾移植后腺病毒肾炎（post-kidney transplant adenovirus nephritis）是一种可引发急性移植肾功能不全（acute allograft dysfunction）的病症，目前针对其临床管理的相关研究证据较为匮乏。方法：本研究为一项原创性病例系列研究，样本取自2009年至2023年间，某肾脏病理专科医疗中心留存的7例患者的肾活检（kidney biopsy）组织。同时，本研究还针对已发表文献中报道的相关病例开展了非系统性文献综述。结果：所有患者均通过肾活检明确诊断。患者肾移植后至确诊的平均时长为32.9个月。最常见的临床症状为发热、肉眼血尿（macroscopic hematuria）及排尿困难（dysuria）。患者的肾小球滤过率（glomerular filtration rate, GFR）较基线水平平均下降四倍。肾活检的核心病理表现为急性肾小管坏死（acute tubular necrosis，100%）、坏死性肉芽肿性间质性肾炎（necrotic granulomatous interstitial nephritis，100%）及病毒包涵体（viral inclusions，100%）。本研究采用的治疗方案包括人免疫球蛋白（human immunoglobulins）、抗病毒药物（antivirals）及免疫抑制（immunosuppression）方案减量。7例患者中有6例临床转归良好。本次文献综述共检索到44例腺病毒间质性肾炎（adenovirus interstitial nephritis）病例，其中绝大多数报道病例的结局良好。结论：腺病毒间质性肾炎是一种罕见病症，但对肾移植受者具有重要的临床意义。肾活检在该病症的确诊中发挥着至关重要的作用。本研究填补了当前腺病毒间质性肾炎相关研究领域的文献空白，有助于加深对肾移植受者随访期间该潜在并发症的认识与理解。