Polyomavirus BK infection in pediatric kidney-allograft recipients: a single-center analysis of incidence, risk factors, and novel therapeutic approaches

Ginevri, Fabrizio; Santis, Riccardo De; Comoli, Patrizia; Pastorino, Nadia; Rossi, Claudia; Botti, Gerardo; Fontana, I.; Nocera, Arcangelo; Cardillo, Massimo; Ciardi, Maria Rosa; Locatelli, Franco; Maccario, Rita; Perfumo, Francesco; Azzi, Alberta

doi:10.1097/01.tp.0000061767.32870.72

Cited by 179 publications

(199 citation statements)

References 18 publications

(24 reference statements)

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“…Besides these high frequencies of BKV infection signals, 5,21,[23][24][25][26] this study also confi rms the previous evidence of no clinical or histopathological characteristics associated with BKV infection. 2,24,26,27,28 In agreement with others, [26][27][28] there was no association with acute rejection or with its treatment. On the other hand, reinforcing the importance of an early diagnosis, no case of viremia among patients with current CAN highlights their probable severe renal damage hindering the viral replication.…”

Section: Discussionsupporting

confidence: 71%

BKV-infection in kidney graft dysfunction

Montagner¹,

Michelon²,

Fontanelle³

et al. 2010

Braz J Infect Dis

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Introduction: BKV nephropathy (BKN) causes kidney graft loss, whose specifi c diagnosis is invasive and might be predicted by the early detection of active viral infection. Objective: Determine the BKV-infection prevalence in late kidney graft dysfunction by urinary decoy cell (DC) and viral DNA detection in urine (viruria) and blood (viremia; active infection). Methods: Kidney recipients with >1 month follow-up and creatinine >1.5 mg/dL and/or recent increasing >20% (n = 120) had their urine and blood tested for BKV by semi-nested PCR, DC searching, and graft biopsy. PCR-positive patients were classifi ed as 1+, 2+, 3+. DC, viruria and viremia prevalence, sensitivity, specifi city, and likelihood ratio (LR) were determined (Table 2x2). Diagnosis effi cacy of DC and viruria were compared to viremia. Results: DC prevalence was 25%, viruria 61.7%, and viremia 42.5%. Positive and negative patients in each test had similar clinical, immunossupressive, and histopathological characteristics. There was no case of viremia with chronic allograft nephropathy and, under treatment with sirolimus, patients had a lower viruria prevalence (p = 0.043). Intense viruria was the single predictive test for active infection (3+; LR = 2.8).

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Section: Discussionsupporting

confidence: 71%

BKV-infection in kidney graft dysfunction

Montagner¹,

Michelon²,

Fontanelle³

et al. 2010

Braz J Infect Dis

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“…The re-emergence of polyomavirus allograft nephropathy (PVAN) has been amply documented in many centers (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). The specific factors that influence outcome are not known, but graft loss has been attributed to a late diagnosis of PVAN in kidneys already showing irreversible tissue damage (scarring) (7).…”

Section: Introductionmentioning

confidence: 99%

Histological Patterns of Polyomavirus Nephropathy: Correlation with Graft Outcome and Viral Load

Drachenberg¹,

Papadimitriou²,

Hirsch

et al. 2004

American Journal of Transplantation

357

389

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“…Furthermore, their study showed that BK viremia of Ն10 4 is characteristic of patients with biopsies that show BKPVAN (23). Additional clinical and histologic studies in larger numbers of patients have confirmed that highlevel viral replication that leads to nephritis is constantly associated with viruria and viremia (20,27,28). The recognition of the succession of events that lead to BKPVAN (viruria-viremianephritis) has provided the rational basis for screening protocols to identify patients who are at risk (18,29 -38).…”

Section: Bk Virus Infection Under Current Immunosuppression Regimensmentioning

confidence: 80%

Histologic versus Molecular Diagnosis of BK Polyomavirus–Associated Nephropathy

Drachenberg

Papadimitriou²,

Ramos³

2006

Clinical Journal of the American Society of Nephrology

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Although discovered in 1970 the BK virus infections had no significant clinical impact until the emergence of BK virusassociated allograft nephropathy (BKPVAN). Escalating clinical challenges required better diagnostic tools and delineation of uniform criteria for diagnosis. In recent years, the widespread use of real-time PCR for measuring viral loads has confirmed that BK viruria and viremia are consistently identified before the development of overt nephritis. The identification of this viruria-viremia-nephritis sequence has provided tools for screening renal transplant patients and the possibility of earlier intervention with improved outcomes. Analysis of current clinical trends indicates that despite the fact that a positive renal biopsy is the "gold standard" for the diagnosis of BKPVAN, clinical interventions often are based on the surrogate markers of the disease rather than on tissue diagnosis. This is conceptually supported by the fact that early BKPVAN is focal and liable to tissue sampling errors. Strong arguments remain, however, in favor of retaining the requirement for tissue evaluation in patients who are suspected of having BKPVAN. BKPVAN selectively affects the graft and is likely to occur in a background of immune and/or nonimmune renal injury. A renal biopsy is necessary to exclude other pathologic processes (e.g., acute rejection) that could coexist with BKPVAN or be the main cause of allograft dysfunction. Evaluation of a renal biopsy for the purpose of staging is important for prognosis and is also of paramount importance for the rational assessment of therapeutic success.

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Polyomavirus BK infection in pediatric kidney-allograft recipients: a single-center analysis of incidence, risk factors, and novel therapeutic approaches

Cited by 179 publications

References 18 publications

BKV-infection in kidney graft dysfunction

BKV-infection in kidney graft dysfunction

Histological Patterns of Polyomavirus Nephropathy: Correlation with Graft Outcome and Viral Load

Histologic versus Molecular Diagnosis of BK Polyomavirus–Associated Nephropathy

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