Plasma cell infiltrates in polyomavirus nephropathy

Transpl Int. 2010 Apr 1;23(4):397-406. doi: 10.1111/j.1432-2277.2009.01001.x. Epub 2009 Nov 12.

Abstract

Polyomavirus (PV) associated nephropathy (PVAN) has become an important cause of allograft dysfunction. We studied plasma cells (PCs) - which have not yet been characterized - present in the cellular infiltrate of 20 PVAN cases using immunohistochemistry and morphometry. The results were correlated with morphological, clinical and anti-BK virus serological findings. PC-rich cellular infiltrates occurred in 50% of cases (>15% PCs in the cellular infiltrate) and in these IgM producing PCs were commonly seen (70%): IgM PC predominance in 50% of cases and a comparable number of IgM and IgG PCs in 20% of cases. We found a significant correlation not just between the absolute numbers (P < 0.034) and the percentage values of IgM PCs (P < 0.004 in relation to all cells) and the serum IgM-Ab anti-BKV activity, but also between the ratio of IgG/IgM PCs and the ratio of serum IgG/IgM-Ab activities (P < 0.0001). We showed that IgM PC counts in biopsies correlate with titers of circulating anti-BK virus IgM antibodies. Every case except one was C4d negative in peritubular capillaries (PTC). As IgG PCs characterize PC-rich rejection cases, we suggest that in the presence of IgM PCs in PC-rich infiltrate with PTC C4d negativity, a search for possible PVAN infection should be initiated.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy
  • Capillaries / metabolism
  • Child
  • Female
  • Humans
  • Immunoglobulin G / metabolism
  • Immunoglobulin M / metabolism
  • Immunohistochemistry / methods
  • Male
  • Middle Aged
  • Plasma Cells / cytology*
  • Plasma Cells / virology
  • Polyomavirus / metabolism*
  • Polyomavirus Infections / blood*

Substances

  • Immunoglobulin G
  • Immunoglobulin M