[Polyomavirus BK-associated nephropathy after kidney transplantation].
Polyomavirus BK (BKV) infection has been lately recognized as a major cause of renal allograft dysfunction. BKV-related interstitial nephropathy (PVAN) may affect 1-10% of renal allograft recipients, occurring more frequently in the first 6 months after transplantation. Progression to irreversible allograft failure has been observed in up to 45% of all cases; thanks to increased PVAN awareness and improved diagnostic techniques, the rate of graft loss has lowered, more consistently in centres with active screening and intervention programs. PVAN pathogenesis is characterized by multiple synergizing factors, among which immunodepression plays a key role. PVAN diagnosis requires the evaluation of a renal biopsy showing polyomavirus cytopathic changes and confirming BKV through an ancillary technique such as immunohistochemistry. Given the focal nature of the disease, early diagnosis may be difficult to obtain. Thus, quantification of BKV-DNA in plasma has been suggested as surrogate marker for PVAN. To date, given the lack of controlled trials, there is no consensus on a 'standard' management of PVAN. However, evidence based on reported observations suggests that a step-wise reduction of immunosuppression, preceded by pulsed steroids in case of coexistent acute rejection, may improve outcomes. Additional options may be represented by drugs with antiviral activity, such as cidofovir, leflunomide or quinolones. Application of a preventive treatment based on viremia monitoring has been recently proposed.
Ginevri
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Unità di Nefrologia, Modulo di Assistenza Trapianto Renale, Istituto G. Gaslini, Genova. fabrizioginevri@ospedale-gaslini.ge.it
Azzi
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Botti
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Comoli
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D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000465:Algorithms; D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus / Q000302:isolation & purification*; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation; D009395:Nephritis, Interstitial / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D027601:Polyomavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012307:Risk Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents