Human polyomavirus (BK) infection and ureteric stenosis in renal allograft recipients.

Abstract

SUMMARY Human polyomavirus (BK) was detected in two renal allograft recipients as a result of routine examination of Papanicolaou-stained smears of urinary sediment in the light microscope. Infection with this recently identified virus was confirmed by virus isolation and electron microscopy. The cytological, histological, and ultrastructural changes due to the virus are described, and virus excretion is correlated with the clinical progress of the patients and the pathological findings. The transplant ureters in both patients were found to be ulcerated and stenosed, and virus-infected cells were observed in the ureteric epithelium. We suggest that the administration of high-dose steroids in transplantation may permit active infection with human polyomavirus to occur in ureteric epithelium which has been damaged by ischaemia or inflammation.Infection with human polyomavirus (BK) was first described by Gardner et al. (1971), who isolated the virus from the urinary tract of a renal allograft recipient. The patient (BK) developed clinical evidence of ureteric obstruction coincident with the virus infection, and at laparotomy a segment ofdonor ureter was found to be ulcerated and stenosed. Since this initial observation was made, serological studies have shown that reactivation of latent BK virus is common in renal allograft recipients (Coleman et al., 1973b) and polyomavirus particles have been observed in the urine of 44% of transplant patients (Lecatsas et al., 1973); but, despite the frequency of infection, there have been no further case reports of BK virus infection associated with ureteric stenosis or obstruction.In this paper we report pathological changes in two patients who were found to have active infection with human polyomavirus (BK) after renal transplantation. BK virus infection was suspected when numerous large inclusion-bearing cells were seen in routine Papanicolaou smears of the urinary sediment, and the cytological diagnosis was confirmed by electron microscopy and virus isolation. Examination of postmortem material and surgical specimens revealed that, in both cases, BK virus infection was associated with narrowing, fibrosis, and ulceration of the donor ureter.Received for publication 20 October 1977 Special methods of investigation CYTOLOGY Ten millilitres of freshly voided urine were concentrated by centrifugation and the deposit was resuspended in 1 ml of the supernatant urine. Three slides were made from the cell suspension by cytocentrifugation (Shandon-Elliot). Two slides were stained by the Papanicolaou method and the third by methyl green pyronin. The slides were screened by light microscopy for activated lymphocytes, inclusionbearing cells, renal tubular cells, and casts. ELECTRON MICROSCOPYTen millilitres of urine were concentrated by centrifugation and the deposit was resuspended in 0 5 ml of supernatant placed in a conical polyethylene embedding capsule and centrifuged again. The supernatant in the capsule was discarded, leaving a button of cells in the point of the capsule. A 1 ...

Characterization of BK virus variants rescued from human tumours and tumour cell lines

“…BKVinduced acute diseases in immunocompetent individuals affect mainly the upper respiratory apparatus (Goudsmit et al, 1981(Goudsmit et al, , 1982 and the urinary tract (Hashida et al, 1976;Mininberg et al, 1982). In immunodeficient or immunosuppressed hosts, BKV latent infection is reactivated (Andrews et al, 1988) and produces lesions in the urinary apparatus (Coleman et al, 1978), the most severe of which is haemorrhagic cystitis in bone marrow transplant recipients (Arthur et al, 1988).…”

Histologic versus Molecular Diagnosis of BK Polyomavirus–Associated Nephropathy

“…The association between renal transplantation and shedding of polyomavirus in the urine was established firmly by subsequent studies (10,(12)(13)(14). The reported incidence of viruria in patients who received azathioprine and prednisone ranged from 14 to 68%, depending on the method used to demonstrate the infection (10,(12)(13)(14)(15)(16).…”

“…The reported incidence of viruria in patients who received azathioprine and prednisone ranged from 14 to 68%, depending on the method used to demonstrate the infection (10,(12)(13)(14)(15)(16).…”

BK virus-associated bilateral ureteric stenosis after haematopoietic SCT: viral kinetics and successful treatment

“…2 In a descriptive study, obstructive uropathy due to ureteric stenosis secondary to BKV-associated HC had also been reported. 12 Therefore, ureteric stenosis appears to be also a problem, albeit rare, post HSCT.…”

“…1 Initial concerns of BKV infection were focused on this complication. 2 Interest in BKV later shifted to its role in haemorrhagic cystitis (HC) after haematopoietic SCT, 3 and in polyomavirus-associated nephropathy (PVAN) after renal allografting. 4 An important difference exists between the two: high levels of BKV viraemia are found in PVAN but not in HC post HSCT, where only high levels of BKV viruria are found.…”