Abstract
Background: In kidney transplant patients, polyomavirus-associated nephropathy (PVAN) represents a serious complication; the key factor for the development of PVAN is immunosuppression level and modulation of anti-rejection treatment represents the first line of intervention. Allograft biopsy and histology remain the criterion standard for diagnosing PVAN. Methods: All consecutive renal biopsies with the diagnosis of PVAN carried out at the University Hospital City of Health and Science of Turin over a five-years period were studied. Renal allograft biopsy was performed due to renal function alterations associated to medium-high polyomavirus BK (BKV)-DNA levels on plasma specimen. Results: A total of 21 patients underwent a first biopsy to diagnose a possible BKV nephropathy, in 18, a second biopsy was made, in eight, a third biopsy, and finally, three underwent the fourth renal biopsy; following the results of each biopsies, immunosuppressant agents dosages were modified in order to reduce the effect of PVAN. Conclusions: In this study, the clinical and histological features of 21 kidney transplant recipients with BKV reactivation and development of PVAN are described. To date, the only treatment for PVAN consists in the reduction of immunosuppressive agents, constantly monitoring viral load.
Highlights
Polyomavirus BK (BKV) belongs to the Polyomaviridae family and is ubiquitously distributed throughout the general population [1,2]
Two serious complications associated to BKV reactivation have been reported: polyomavirus associated nephropathy (PVAN) and polyomavirus associated hemorrhagic cystitis (PyVHC) [6,7,8]
We describe the features of polyomavirus-associated nephropathy (PVAN) cases observed at the Turin Renal Transplant
Summary
Polyomavirus BK (BKV) belongs to the Polyomaviridae family and is ubiquitously distributed throughout the general population [1,2]. 30–50% of kidney transplant patients with high-level of BKV viruria and viremia progress to PVAN [9,10,11,12]. Allograft biopsy and histology remain the criterion standard for diagnosing PVAN. Results: A total of 21 patients underwent a first biopsy to diagnose a possible BKV nephropathy, in 18, a second biopsy was made, in eight, a third biopsy, and three underwent the fourth renal biopsy; following the results of each biopsies, immunosuppressant agents dosages were modified in order to reduce the effect of PVAN. Conclusions: In this study, the clinical and histological features of 21 kidney transplant recipients with BKV reactivation and development of PVAN are described. The only treatment for PVAN consists in the reduction of immunosuppressive agents, constantly monitoring viral load
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