Adenovirus nephritis in adult kidney allograft recipients: a systematic review of literature.

Background: Adenovirus nephritis is an increasingly recognized complication in adult kidney transplant recipients, characterized by its diverse clinical presentations and diagnostic challenges. This systematic review summarises the clinical profiles and outcomes of adenoviral nephritis in kidney allograft recipients.

Methods: We conducted a systematic search of PubMed, Embase, and Web of Science for studies (case reports or series) with individual patient data on adult kidney transplant recipients with confirmed or presumptive adenoviral nephritis up to October 2, 2024. Clinical profile, treatment and outcome data with adenoviral nephritis were collected and summarised for all patients. We compared features of early and late adenoviral nephritis (diagnosis before and after 90 days post-transplantation).

Results: Thirty-nine studies met inclusion criteria, involving 57 patients with a mean age of 45.7 years and a male predominance. The median time to infection post-transplant was 168 days. The most common symptoms were fever (68.5%), dysuria (49%) and diarrhoea (21%). Early adenoviral infection was more common in cadaveric graft recipients. Fever and gross haematuria were more common in late adenoviral infections. Biopsies showed interstitial nephritis (100%), with some having acute tubular necrosis (53%). Granulomas were seen in 61.2%. Glomeruli and peritubular capillaries were not affected in any of the biopsies. Reversible graft dysfunction was observed in 75% of cases, while mortality was noted in three patients.

Conclusion: Adenoviral nephritis is associated with diverse clinical manifestations with differing chronology post-transplantation. Graft dysfunction is associated with reversible interstitial nephritis. Further research is necessary to improve outcomes.