Ultrasound findings of BK polyomavirus-associated nephropathy in renal transplant patients

Dugo, Mauro; Mangino, Margherita; Meola, Mario; Petrucci, Ilaria; Valente, M.; Laurino, Licia; Stella, Mario; Mastrosimone, Stefania; Brunello, Anna; Virgilio, Bice; Rizzolo, Monica; Maresca, Maria Cristina

doi:10.1007/s40620-016-0327-0

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…Sharma et al [ 11 ] analyzed 6017 ultrasonic scans performed in 614 patients with 462 episodes of acute rejection from 1992 to 2000, and reported that a >10% increase over the previous ‘best’ RI had a sensitivity of 60% and a specificity of 90% for the diagnosis of acute rejection. Dugo et al [ 13 ] found that ultrasound showed typical hypoechoic lesions with irregular edges in the cortex of BKVAN patients, suggesting that ultrasound can be useful for the non-invasive diagnosis of BKVAN when combined with blood and urine screening tests. Cano et al [ 14 ] reviewed the literature from the past 10 years and concluded that an elevated RI is an early predictor of histologically relevant chronic allograft nephropathy.…”

Section: Discussionsupporting

confidence: 85%

Color Doppler Ultrasound and Hemodynamics for Evaluating Graft Dysfunction in Recurrent Immunoglobulin A Nephropathy

et al. 2021

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Background The aim of this study was to investigate the diagnostic and prognostic utility of color Doppler ultrasound for graft dysfunction in recurrent immunoglobulin A nephropathy (IgAN). Material/Methods We selected a series of 78 biopsies diagnostic of recurrent IgAN following living-donor transplantation from July 2004 to January 2019. Based on Lee’s classification, Doppler parameters in different degrees of histopathological injury were retrospectively analyzed. Results The 4-year cumulative graft survival rate after biopsy was 66.3%, and the difference among the Kaplan-Meier curves of Lee’s classification ( P <0.01) was significant. Doppler parameters showed that echo enhancement, decreasing blood flow distribution, decreasing end-diastolic velocity (EDV) of the main renal artery (MRA), segmental renal atery (SRA) and interlobar renal artery (IRA), and an elevated resistance index (RI) of the arcuate renal artery (ARA) were significantly different among grades I-V of Lee’s classification ( P <0.05). Logistic multivariate analysis indicated that echo enhancement (HR 13.6, 95% CI 2.7–68.4) and decreasing EDV of the SRA (HR 1.1 for a 1-cm/s, 95% CI 1.0–1.2) were independent predictors of severe injury (IV–V). The ROC curve fitted by echo enhancement and decreasing EDV of the SRA had an area under the curve of 0.87. The cutoff was 17.5 cm/s (decreasing EDV of the SRA) without echo enhancement. The sensitivity and specificity were 72.2% and 91.7%, respectively. Conclusions Color Doppler ultrasound successfully evaluated the graft dysfunction in recurrent IgAN; a decreasing EDV of the SRA indicated severe histopathological injury and poor prognosis.

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Section: Discussionsupporting

confidence: 85%

Color Doppler Ultrasound and Hemodynamics for Evaluating Graft Dysfunction in Recurrent Immunoglobulin A Nephropathy

et al. 2021

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“…Despite heterogeneous parenchymal distribution compounded by the prominent inflammatory reactions, serial biopsies in PyVAN demonstrate overall progression of fibrosis. In this context, the contribution of PyVAN to graft loss due to development of graft sclerosis cannot be underestimated .…”

Section: Discussionmentioning

confidence: 99%

Histological Evolution of BK Virus–Associated Nephropathy: Importance of Integrating Clinical and Pathological Findings

Drachenberg

Chaudhry

Ugarte

et al. 2017

American Journal of Transplantation

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Long-term clinicopathological studies of BK-associated nephropathy (PyVAN) are not available. We studied 206 biopsies (71 patients), followed 3.09 ± 1.46 years after immunosuppression reduction. The biopsy features (% immunostain for PyV large T ag + staining and inflammation ± acute rejection) were correlated with viral load dynamics and serum creatinine to define the clinicopathological status (PyVCPS). Incidence of acute rejection was 28% in the second biopsy and 50% subsequently (25% mixed T cell-mediated allograft rejection (TCMR) + antibody-mediated allograft rejection (AMR); rejection overall affected 38% of patients (>50% AMR). Graft loss was 15.4% (0.8-5.3 years after PyVAN); 76% had complete viral clearance (mean 28 weeks). The only predictors of graft loss were acute rejection (TCMR p = 0.008, any type p = 0.07), and increased "t" and "ci" in the second biopsy (p = 0.006 and 0.048). Higher peak viremia correlated with poorer viral clearance (p = 0.002). Presumptive and proven PyVAN had similar presentation, evolution, and outcome. Late PyVAN (>2 years, 9.8%) justifies BK viremia evaluation at any point with graft dysfunction and/or biopsy evaluation. This study describes the histological evolution of PyVAN and corresponding clinicopathological correlations. Although the pathological features overall reflect the viral and immunological interactions, the PyVAN course remains difficult to predict based on any single feature. Appropriate clinical management requires repeat biopsies and determination of the PyVCPS at relevant time points, for corresponding personalized immunosuppression adjustment.

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“…Thus far, published imaging features associated with polyomavirus nephropathy include a streaky pattern of alternating hypoechoic bands at grayscale US with increased RIs in the renal arteries at Doppler interrogation, signifying nonspecific nephritis (Fig 14). At contrast-enhanced CT, this may appear as areas of streaky or wedgelike hypoenhancement extending from the papilla to the cortex (118,119). However, as a result of continued immunosuppression, these patients remain at increased risk for opportunistic pathogens such as Nocardia and fungal organisms such as Aspergillus and Mucor species.…”

Section: Infectious Complicationsmentioning

confidence: 99%

Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review

et al. 2019

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The kidney is the most commonly transplanted solid organ. Advances in surgical techniques, immunosuppression regimens, surveillance imaging, and histopathologic diagnosis of rejection have allowed prolonged graft survival times. However, the demand for kidneys continues to outgrow the available supply, and there are efforts to increase use of donor kidneys with moderate-or highrisk profiles. This highlights the importance of evaluating the renal transplant patient in the context of both donor and recipient risk factors. Radiologists play an integral role within the multidisciplinary team in care of the transplant patient at every stage of the transplant process. In the immediate postoperative period, duplex US is the modality of choice for evaluating the renal allograft. It is useful for establishing a baseline examination for comparison at future surveillance imaging. In the setting of allograft dysfunction, advanced imaging techniques including MRI or contrastenhanced US may be useful for providing a more specific diagnosis and excluding nonrejection causes of renal dysfunction. When a pathologic diagnosis is deemed necessary to guide therapy, USguided biopsy is a relatively low-risk, safe procedure. The range of complications of renal transplantation can be organized temporally in relation to the time since surgery and/or according to disease categories, including immunologic (rejection), surgical or iatrogenic, vascular, urinary, infectious, and neoplastic complications. The unique heterotopic location of the renal allograft in the iliac fossa predisposes it to a specific set of complications. As imaging features of infection or malignancy may be nonspecific, awareness of the patient's risk profile and time since transplantation can be used to assign the probability of a certain diagnosis and thus guide more specific diagnostic workup. It is critical to understand variations in vascular anatomy, surgical technique, and independent donor and recipient risk factors to make an accurate diagnosis and initiate appropriate treatment. ©

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Ultrasound findings of BK polyomavirus-associated nephropathy in renal transplant patients

Cited by 9 publications

References 10 publications

Color Doppler Ultrasound and Hemodynamics for Evaluating Graft Dysfunction in Recurrent Immunoglobulin A Nephropathy

Color Doppler Ultrasound and Hemodynamics for Evaluating Graft Dysfunction in Recurrent Immunoglobulin A Nephropathy

Histological Evolution of BK Virus–Associated Nephropathy: Importance of Integrating Clinical and Pathological Findings

Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review

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