title: Polyomavirus BK infection in pediatric kidney-allograft recipients: a single-center analysis of incidence, risk factors, and novel therapeutic approaches.
abstract: BACKGROUND
  Although a growing body of literature regarding polyoma BK virus (BKV) infection and associated interstitial nephritis in kidney-allograft recipients is becoming available, the impact of BKV infection in the pediatric population has not been fully evaluated.
  
  
  METHODS
  In a retrospective analysis, we performed polymerase chain reaction (PCR) assays for BKV DNA in serum and urine samples from 100 pediatric kidney-allograft recipients referred to our institution in the last 5 years.
  
  
  RESULTS
  BKV viruria was observed in 26 of 100 patients, whereas BKV viremia was demonstrated in 5 patients. Serum creatinine was significantly higher in recipients with positive BK viremia compared with BKV DNA-negative patients (mean 2.66 vs. 1.14 mg/100 mL). Renal biopsy performed in 3 of 5 patients showed graft damage consistent with interstitial nephropathy. In the univariate analysis, negative antibody status of the recipient and the presence of mycophenolate mofetil in baseline immunosuppression were the two factors predictive of active BKV infection.
  
  
  CONCLUSIONS
  Our study shows that BKV-associated nephropathy is a relevant complication in the pediatric kidney transplantation setting also. Identification of patients at risk of developing virus-associated nephropathy, through prospective quantification of viral load, could improve clinical outcome by allowing the use of timely preemptive therapy guided by BKV DNA levels.
authors.affiliation: Pediatric Nephrology Unit, G. Gaslini Institute, Genova, Italy. fabrizioginevri@ospedale-gaslini.ge.it.
authors.forename: F
authors.initials: F
authors.lastname: Ginevri
authors.forename: R
authors.initials: R
authors.lastname: De Santis
authors.forename: P
authors.initials: P
authors.lastname: Comoli
authors.forename: N
authors.initials: N
authors.lastname: Pastorino
authors.forename: C
authors.initials: C
authors.lastname: Rossi
authors.forename: G
authors.initials: G
authors.lastname: Botti
authors.forename: I
authors.initials: I
authors.lastname: Fontana
authors.forename: A
authors.initials: A
authors.lastname: Nocera
authors.forename: M
authors.initials: M
authors.lastname: Cardillo
authors.forename: M R
authors.initials: MR
authors.lastname: Ciardi
authors.forename: F
authors.initials: F
authors.lastname: Locatelli
authors.forename: R
authors.initials: R
authors.lastname: Maccario
authors.forename: F
authors.initials: F
authors.lastname: Perfumo
authors.forename: A
authors.initials: A
authors.lastname: Azzi
mesh_terms: D000293:Adolescent; D000328:Adult; D001739:BK Virus / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000821:virology*; D016030:Kidney Transplantation; D008297:Male; D027601:Polyomavirus Infections / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous; D014556:Urine / Q000821:virology; D014766:Viremia / Q000209:etiology