Pathological characteristics of BK polyomavirus-associated nephropathy with glomerular involvement

Chen, Xu-Tao; Deng, Ronghai; Yang, Shicong; Hou, Xin; Li, Jun; Chen, Yan-Yang; Yang, Hui-Fei; Wang, Zeyuan; Wang, Changxi; Qiu, Jian; Chen, Lizhong; Chen, Wenfang; Huang, Gang

doi:10.21037/atm-20-1879

Cited by 4 publications

(1 citation statement)

References 23 publications

(21 reference statements)

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“…In definitive PVN cases, glomerular infection by BKV and subsequent crescent formation were seen in 24.4% and 11.4%, respectively. [ 11 ] As in other conditions, the crescent formation in PVN can reduce single nephron GFR drastically and cause rapid deterioration of renal function.…”

Section: Discussionmentioning

confidence: 99%

Glomerulonephritis with crescents in polyomavirus nephropathy

et al. 2022

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Polyomavirus nephropathy (PVN) is a known complication of renal transplantation due to the reactivation of latent BK virus (BKV) infection. Viral replication is usually confined to tubules. However, in severe viremia and late stages of PVN, it can involve glomerular parietal epithelial cells. Glomerular involvement by BKV can cause crescent formation and may lead to graft failure. We describe a relatively rare case of PVN with glomerular involvement and crescent formation in a 52-year-old male who had undergone a transplant 16 months ago. Despite the stoppage of immunosuppression, graft failure occurred eventually. Interestingly, we observed the intense positivity for IgG and c4d in the Bowman capsule on immunofluorescence. Observation of such positivity along Bowman capsule in renal biopsies with a limited number of glomeruli should alert pathologists to do a vigilant search of BKV inclusion and perform immunohistochemistry for SV 40 large T antigen.

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Section: Discussionmentioning

confidence: 99%

Glomerulonephritis with crescents in polyomavirus nephropathy

et al. 2022

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A Unique Case of Invagination of BK Polyomavirus-Infected Tubular Cells into Bowman’s Space in a Heart Transplant Patient With Acute Kidney Injury

Montemayor-Villacobos,

Montero-Granados,

Alfaifi

et al. 2024

Kidney Medicine

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The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation

Kotton,

Kamar,

Wojciechowski

et al. 2024

Transplantation

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BK polyomavirus (BKPyV) remains a significant challenge after kidney transplantation. International experts reviewed current evidence and updated recommendations according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Risk factors for BKPyV-DNAemia and biopsy-proven BKPyV-nephropathy include recipient older age, male sex, donor BKPyV-viruria, BKPyV-seropositive donor/-seronegative recipient, tacrolimus, acute rejection, and higher steroid exposure. To facilitate early intervention with limited allograft damage, all kidney transplant recipients should be screened monthly for plasma BKPyV-DNAemia loads until month 9, then every 3 mo until 2 y posttransplant (3 y for children). In resource-limited settings, urine cytology screening at similar time points can exclude BKPyV-nephropathy, and testing for plasma BKPyV-DNAemia when decoy cells are detectable. For patients with BKPyV-DNAemia loads persisting >1000 copies/mL, or exceeding 10 000 copies/mL (or equivalent), or with biopsy-proven BKPyV-nephropathy, immunosuppression should be reduced according to predefined steps targeting antiproliferative drugs, calcineurin inhibitors, or both. In adults without graft dysfunction, kidney allograft biopsy is not required unless the immunological risk is high. For children with persisting BKPyV-DNAemia, allograft biopsy may be considered even without graft dysfunction. Allograft biopsies should be interpreted in the context of all clinical and laboratory findings, including plasma BKPyV-DNAemia. Immunohistochemistry is preferred for diagnosing biopsy-proven BKPyV-nephropathy. Routine screening using the proposed strategies is cost-effective, improves clinical outcomes and quality of life. Kidney retransplantation subsequent to BKPyV-nephropathy is feasible in otherwise eligible recipients if BKPyV-DNAemia is undetectable; routine graft nephrectomy is not recommended. Current studies do not support the usage of leflunomide, cidofovir, quinolones, or IVIGs. Patients considered for experimental treatments (antivirals, vaccines, neutralizing antibodies, and adoptive T cells) should be enrolled in clinical trials.

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Pathological characteristics of BK polyomavirus-associated nephropathy with glomerular involvement

Cited by 4 publications

References 23 publications

Glomerulonephritis with crescents in polyomavirus nephropathy

Glomerulonephritis with crescents in polyomavirus nephropathy

A Unique Case of Invagination of BK Polyomavirus-Infected Tubular Cells into Bowman’s Space in a Heart Transplant Patient With Acute Kidney Injury

The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation

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