Native kidney BK virus nephropathy, a systematic review

Abstract

Background: There is a growing base of literature describing BK nephropathy (BKVN) in patients outside of the setting of kidney transplant. Previous systematic reviews of the literature have been limited by methodology or by the scope of patients included. Study Design and Methods:Systematic Review (Prospero # CRD42018088524). Setting & Population:Patients without kidney transplant who had biopsy-proven BKVN. Selection Criteria for Studies:Full-text articles that describe native BKVN patient cases.Analytical Approach: Descriptive synthesis. Results:The search identified 630 unique articles of which 51 were included in the final review. Sixty-five cases (including two new cases presented in this review) were identified, all but one occurred in the setting of known immunosuppression. Limitations:The primary limitation was the exclusion of studies that did not fulfill the stringent review criteria. We excluded reports with only a clinical diagnosis of BKVN, such as those with viruria and/or viremia without biopsy. Conclusions:As of May 2018, there are 65 reported cases of BKVN in native kidneys.This represents the most comprehensive description of biopsy-proven BKVN in native kidneys to date. Evaluation for BK nephropathy should be considered in immunocompromised patients who exhibit unexplained renal failure. K E Y W O R D S

BK virus encephalitis and end‐stage renal disease in a child with hematopoietic stem cell transplantation

“…Approximately, 80% of RT recipients develop BK viruria, and 5%‐10% of these patients develop BKVN within a year post‐RT with allograft loss in about 50% 2 . However, several reports of native kidney BK nephropathy in both adult and pediatric non‐RT patients have been described in the recent literature 3 . This includes patients with HSCT, non‐renal SOT, HIV, hematological malignancies, and other immunodeficiency conditions 4,5 .…”

BK Virus Nephropathy in the Native Kidney of a Liver Transplant Recipient

“…In a recent review of the literature by Shah et al, biopsy-proven BKVN developing in the setting of solid organ transplantation accounted for approximately one third of all cases occurring in the native kidney. 5 With respect to BKVN in the native kidney, review of the literature reveals 3 liver (including the case reported herein), 13 heart, 6 lung, and 1 pancreas transplant recipients. Cases are described in both pediatric and adult populations, men and women, affect differing races, with variable combinations of immunosuppression, and with antiviral management strategies.…”

“…heart, lung, liver), hematologic malignancy (variably with bone marrow transplantation), and autoimmune disease. 4,5 Biopsy-proven BKVN in liver transplant recipients has been described sparingly. Lai et al described a 59-year-old male who was 2 years status post liver transplantation and presented acutely with biopsy-proven cytomegalovirus colitis, acute kidney injury (serum creatinine of 280 µmol/L), biopsy-proven BKVN, and 754,976 copies/mL of BK-virus in the serum.…”

BK virus nephropathy in non‐renal solid organ transplant recipients: Are we looking hard enough?

“…Native kidney BKV associated disease in non‐renal solid organ transplant (NRSOT) recipients has been described in case reports and series over the years, but it has not been systematically studied 12‐35 . BKV nephropathy in the NRSOT recipient has the potential to lead to chronic kidney disease (CKD) or end‐stage renal disease (ESRD) with associated morbidity and mortality 36‐38 .…”