Intravenous immunoglobulin as rescue therapy for BK virus nephropathy.
BKVN has emerged as an important cause of pediatric renal allograft nephropathy, with significant graft dysfunction in majority of the cases. Reduced immunosuppression and cidofovir therapy are the most commonly used therapeutic options for the treatment of BKVN in these patients. Recently, a preliminary study in adult renal allograft recipients with BKVN showed a therapeutic response to a combined approach of immunosuppression reduction and IVIg administration. A therapeutic benefit of IVIg without another concomitant treatment intervention has not been evaluated. We report stabilization of renal functions, histological resolution of BKVN and significant reduction in BK viremia in pediatric renal transplant with the use of IVIg, after an inadequate response to immunosuppression reduction and cidofovir therapy. In addition, we review the current literature on the use of cidofovir in pediatric renal transplant patients with BKVN and the potential of IVIg use in this condition.
Sharma
Ajay P
AP
Department of Paediatrics, Division of Nephrology, University of Western Ontario, London, Ontario, Canada. ajay.sharma@lhsc.on.ca
Moussa
Madeleine
M
Casier
Shelley
S
Rehman
Faisal
F
Filler
Guido
G
Grimmer
Joanne
J
D000998:Antiviral Agents / Q000008:administration & dosage; D001739:BK Virus; D002675:Child, Preschool; D000077404:Cidofovir; D003404:Creatinine / Q000097:blood; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D015774:Ganciclovir / Q000008:administration & dosage; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use; D027601:Polyomavirus Infections / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D014412:Tumor Virus Infections / Q000276:immunology / Q000473:pathology / Q000628:therapy*
D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D063065:Organophosphonates; D003596:Cytosine; D003404:Creatinine; D000077404:Cidofovir; D015774:Ganciclovir