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Conceptual Problems in the Diagnosis and Therapy of Acute Rejection in Patients with Polyomavirus Nephropathy

We appreciate the comments on our study (1) made by Dr Nickeleit and Dr Mihatsch, and agree that arteritis, glomerulitis, and C4d deposits may be used to diagnose acute rejection in patients with polyomavirus infection. Unlike them, we do not like to read too much into tubulitis and interstitial inflammation being present in areas away from obvious viral cytopathic effect. It is our belief that virusinduced cytokines could easily diffuse locally and ‘act at a distance’ a few hundred microns away from an area with overt viral inclusions.