Polyomavirus nephropathy in kidney transplantation.
Polyomavirus nephropathy has become an important complication in kidney transplantation, with a prevalence of 1% to 8%. Unfortunately, the risk factors for polyomavirus nephropathy and renal allograft loss are not well defined. The definitive diagnosis is made through assessment of a kidney transplant biopsy. Recently, noninvasive urine and serum markers have been used to assist in polyomavirus nephropathy diagnosis and monitoring. Primary treatment is immunosuppression reduction, but must be balanced with the risks of rejection. No antiviral treatments for polyomavirus nephropathy have been approved by the Food and Drug Administration. Although cidofovir has shown in vitro activity against murine polyomaviruses, and has been effective in some patients, it is associated with significant nephrotoxicity. Graft loss due to polyomavirus nephropathy should not be a contraindication to retransplantation; however, experience is limited. This review presents potential risk factors, screening, diagnostic and monitoring methods, therapeutic management, and retransplantation experience for polyomavirus nephropathy.
Trofe
Jennifer
J
University of Cincinnati, Division of Transplantation, Ohio, USA.
Gordon
Jennifer
J
Roy-Chaudhury
Prabir
P
Koralnik
Igor J
IJ
Atwood
Walter J
WJ
Alloway
Rita R
RR
Khalili
Kamel
K
Woodle
E Steve
ES
D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D001706:Biopsy; D006084:Graft Rejection; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D008403:Mass Screening; D011120:Polyomavirus / Q000145:classification / Q000472:pathogenicity / Q000502:physiology; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012086:Reoperation; D012307:Risk Factors
D000998:Antiviral Agents; D007166:Immunosuppressive Agents