Virus participation in renal damage in AL patients: histopathological study
Ekaterina G. Vorozheikina1, Vladimir V. Varshavski2, Ekaterina P. Golitsina2, Evgenia N. Glasko1, Irina B. Kaplanskaya1, Ljudmila S. Birjukova1, Elena N. Parovichnikova1, Valeriy G. Savchenko1
1National Research Center of Hematology, Moscow, Russia; 2I.M. Sechenov’s Moscow Medical Academy, Russia
National Research Center of Hematology, Novozykovski Pr 4., 125167 Moscow, Russia
Phone: +7 (495) 612 4592, Fax: +7 (495) 6124252
To investigate the morphology and electron microscope characteristics of kidney damage in patients (pts) with AL.
Patients and Methods
Forty-one patients with AL from 2003 to 2008 were observed. RB was performed in 11 pts with functional renal insufficiency (3-ALL, 8-AML); the median age was 38 years (19–67). Autopsy data were studied in 30 pts with renal insufficiency and acute renal failure. Light microscopy, immunohistochemistry, and electron microscopy was used.
In 30 kidney autopsies, tubular interstitial changes with sclerosis prevalence were found. In 2 pts mesangioproliferative glomerulonephritis was revealed. Other changes included the low proliferation of mesangiocytes, arteriolosclerosis of vessels (18pts), and the presence of leukemic infiltration (7pts). Tubular-interstitial changes were found in all patients who underwent RB; in 3 cases glomerulonephritis was found and leukemic infiltration in 2. An immunohistochemical study showed that in all cases tubular epithelium cells and interstice-infiltrating lymphocytes were EBV and HSV ½ positive. CMV was found in 1 case and herpes infection also in 1 case. Increased antiviral IgD levels were found in 10 patients, DNA probes were negative. Renal structural changes analyzed by electron microscopy were difficult to interpret, but in all cases viruses were found in different cell types. We can suppose that renal structural damage was to some extent associated with the presence of viruses.
Kidney damage in acute leukemia is characterized mostly by tubular interstitial changes. We also proved – using electron miscopy and an immunohistochemical study – the massive viral invasion of renal tissue.
acute leukemia, AL, kidney, renal biopsy, RB, autopsy, viruses