Polyomavirus-associated nephropathy: update on antiviral strategies.
Polyomavirus-associated nephropathy (PVAN) is a major complication of kidney transplantation. Many centers respond to PVAN by reducing immunosuppression. Concern over precipitating rejection, as well as situations in which some PVAN-afflicted individuals have multi-organ transplants, can make reduction of immunosuppression undesirable. In these cases, effective antiviral strategies would be useful. This article describes clinical observations and experiences with 3 different antiviral protocols. Two protocols address antiviral treatment of nephropathy (cidofovir in one, and leflunomide in the other). The third protocol examines fluoroquinolone control of polyoma urinary excretion. Patients responded to all 3 strategies. These promising approaches deserve further evaluation with prospective controlled studies.
Josephson
M A
MA
Department of Medicine, University of Chicago, Illinois 60637, USA. mjosephs@medicine.bsd.uchicago.edu
Williams
J W
JW
Chandraker
A
A
Randhawa
P S
PS
D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use*; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D007674:Kidney Diseases / Q000188:drug therapy* / Q000821:virology; D016030:Kidney Transplantation; D000077339:Leflunomide; D063065:Organophosphonates / Q000627:therapeutic use; D011120:Polyomavirus; D027601:Polyomavirus Infections / Q000188:drug therapy*; D015363:Quinolones / Q000627:therapeutic use
D000998:Antiviral Agents; D007555:Isoxazoles; D063065:Organophosphonates; D015363:Quinolones; D003596:Cytosine; D000077339:Leflunomide; D000077404:Cidofovir