We describe a rare case of adenovirus interstitial nephritis in a 37-year-old man, 4 weeks following deceased donor renal transplantation. He presented with gross hematuria and acute graft dysfunction. A renal biopsy revealed necrotizing tubulointerstitial nephritis with intranuclear viral inclusions in the tubular epithelial cells. Immunohistochemistry and polymerase chain reaction confirmed adenovirus infection. Reduction in immunosuppression alone resulted in rapid improvement of graft function. Awareness of the clinical and characteristic biopsy findings may help establish the correct diagnosis, which is crucial as disseminated infection, if left untreated, is associated with a high mortality rate in renal allograft recipients.

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Chronic kidney disease (CKD) is seen in approximately 3% of women of childbearing age. Focal segmental glomerulosclerosis (FSGS) is the most common glomerular disorder that causes end stage renal disease (ESRD). It commonly presents with nephrotic syndrome which increases the risk of pregnancy complications. We report successful pregnancy outcome in a young woman with FSGS and nephrotic syndrome who was not on treatment till 20 weeks of gestation. Antihypertensives and immunosuppressants were titrated. Strict antepartum fetal surveillance and follow-up with nephrologist were done. Caesarean section was performed at 32 weeks because of rising proteinuria despite therapy and IUGR. Post-operative recovery was uneventful. Resolution of proteinuria is the cornerstone in the management of FSGS as this delays the progression of the disease.