Clinicopathologic analysis of patients with BK viruria and rejection-like graft dysfunction.
BK virus infection can be associated with interstitial inflammation, tubulitis without viral cytopathic effect, and negative in situ hybridization for viral DNA. We evaluated the consequences of increased immunosuppression in 32 viruric patients, with such acute cellular rejection-like changes in allograft biopsies (n = 50). When follow-up information was available, complete creatinine response, decrease in urine viral load (VL), and improvement in overall Banff grade for acute rejection were only seen in 13 (27%) of 49, 7 (21%) of 33, and 10 (39%) of 26 episodes of graft dysfunction, respectively. Histologic response was not always accompanied by clinical response. This low rate of response to antirejection therapy suggests that interstitial nephritis in a subset of these patients was secondary to viral infection. The presence of high VL (>1.0 E+05 copies/mL) was associated with low immune cell function values (129 +/- 99 ng of adenosine triphosphate per milliliter, P = .08) and with significant development of viremia after antirejection treatment (5/9 [56%] versus 0/24 [0%] in patients with low VL, P < .001).
Batal
Ibrahim
I
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. batali2@upmc.edu
Franco
Zachary M
ZM
Shapiro
Ron
R
Basu
Amit
A
Tan
Henkie
H
Kayler
Liise
L
Zeevi
Adriana
A
Morgan
Claire
C
Randhawa
Parmjeet
P
D001739:BK Virus / Q000502:physiology*; D015704:CD4 Antigens / Q000378:metabolism; D003404:Creatinine / Q000097:blood; D004279:DNA, Viral / Q000097:blood / Q000652:urine; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000821:virology; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D017403:In Situ Hybridization; D016030:Kidney Transplantation / Q000276:immunology; D009395:Nephritis, Interstitial / Q000276:immunology / Q000473:pathology / Q000821:virology; D027601:Polyomavirus Infections / Q000821:virology*; D013997:Time Factors; D014184:Transplantation, Homologous / Q000276:immunology; D014556:Urine / Q000821:virology*; D019562:Viral Load; D014766:Viremia / Q000821:virology*
D015704:CD4 Antigens; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D003404:Creatinine