Polyomavirus disease in renal transplantationReview of pathological findings and diagnostic methods

Drachenberg, Cinthia B.; Hirsch, Hans H.; Ramos, Emilio

doi:10.1016/j.humpath.2005.08.009

Cited by 174 publications

(160 citation statements)

References 88 publications

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“…Similarly, for BKPVAN, evaluation of a renal biopsy provides the only means for assessing the disease pattern, including the extent of renal scarring, the type and the extent of the immune response, and the existence of other, concurrent pathologies (8,18,20).…”

Section: Resultsmentioning

confidence: 99%

“…Tissue damage results from a combination of direct viral cytolytic effects and secondary inflammatory responses. The latter may be immune specific or nonspecific in nature (7,8). The intricate interactions between the virus and the immune system lead to various clinicopathologic forms of BK disease, as has been schematized previously by Hirsch (9).…”

Section: Spectrum Of Clinicopathologic Manifestationsmentioning

confidence: 94%

“…The intricate interactions between the virus and the immune system lead to various clinicopathologic forms of BK disease, as has been schematized previously by Hirsch (9). Whereas viral replication may proceed without apparent engagement of the immune response (e.g., BK virusassociated allograft nephropathy [BKPVAN] histologic pattern A, JC in progressive multifocal leukoencephalopathy), the BK infection often triggers the development of a vigorous immune response that may lead to viral clearance (i.e., lymphoid infiltrates in BKPVAN histologic pattern B) (8,9). Excessive or aberrant immune responses to the BK virus may result in diseases such as hemorrhagic cystitis in bone marrow transplantation and autoimmune disorders, respectively (9).…”

Section: Spectrum Of Clinicopathologic Manifestationsmentioning

confidence: 99%

“…Large numbers of cells with intranuclear inclusions were present in the urine. These cells are known as "decoy cells" because of their potential misidentification as malignant cells (8). After surgical correction of the stenosis, the patient recovered satisfactorily and had excellent renal function 7 mo after the diagnosis of BK ureteritis (4).…”

Section: Bk Virus and Renal Transplantation: Historical Perspectivementioning

confidence: 99%

“…Early stages of the disease are difficult to diagnose histologically because of the focal nature of BKPVAN and the resulting possibility of having only uninvolved areas represented in the biopsy core (8,18,20). The negative impact of a falsely negative biopsy is avoided when the renal biopsy is interpreted in the context of viruria's and viremia's serving as surrogate markers of BKPVAN.…”

Section: Early Diagnosis Of Bkpvanmentioning

confidence: 99%

See 4 more Smart Citations

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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Section: Resultsmentioning

confidence: 99%