Polyoma virus nephropathy in native kidneys after lung transplantation.
Polyoma virus nephropathy is recognized as an emerging clinical problem in renal transplantation; however, polyoma in native kidneys is unusual. We report a patient who developed polyoma nephropathy in his native kidneys 15 months after successful lung transplantation. His immunosuppression consisted of tacrolimus, mycophenolate mofetil, and large doses of steroids because of three rejection episodes. When the condition was recognized, cidofovir was an effective treatment (3 doses of 2-3mg/kg); however, his renal function deteriorated nonetheless. Tubulitis and interstitial cell infiltration in his native kidneys were evidence that the changes were in response to viral injury. Polyoma nephropathy of native kidneys is unusual. An earlier course of cisplatin treatment because of metastatic seminoma prior to lung transplantation may have been contributory to pre-existing renal injury. After cidofovir was begun, the polyoma viral load in serum and urine decreased substantially; however, after high-dose steroid treatment of two rejection episodes, each time a significant increase in viral load was seen. We stained biopsies of native kidneys from 30 recipients of other organs. The biopsies were done for various reasons but not because polymoma virus was suspected. We found no additional cases.
Schwarz
Anke
A
Department of Nephrology, Hannover Medical School, Hannover, Germany. schwarz.anke@mh-hannover.de
Mengel
Michael
M
Haller
Hermann
H
Niedermeyer
Jost
J
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus / Q000378:metabolism; D001706:Biopsy; D000077404:Cidofovir; D002945:Cisplatin / Q000627:therapeutic use; D003596:Cytosine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000378:metabolism / Q000473:pathology / Q000821:virology*; D007674:Kidney Diseases / Q000175:diagnosis* / Q000821:virology*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D009362:Neoplasm Metastasis; D063065:Organophosphonates / Q000008:administration & dosage / Q000627:therapeutic use; D011120:Polyomavirus / Q000472:pathogenicity*; D027601:Polyomavirus Infections / Q000175:diagnosis*; D018239:Seminoma / Q000188:drug therapy; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D063065:Organophosphonates; D013256:Steroids; D003596:Cytosine; D009173:Mycophenolic Acid; D000077404:Cidofovir; D002945:Cisplatin; D016559:Tacrolimus