BKV-infection in kidney graft dysfunction.
BACKGROUND
BKV nephropathy (BKN) causes kidney graft loss, whose specific diagnosis is invasive and might be predicted by the early detection of active viral infection.


OBJECTIVE
Determine the BKV-infection prevalence in late kidney graft dysfunction by urinary decoy cell (DC) and viral DNA detection in urine (viruria) and blood (viremia; active infection).


METHODS
Kidney recipients with >1 month follow-up and creatinine >1.5 mg/dL and/or recent increasing >20% (n = 120) had their urine and blood tested for BKV by semi-nested PCR, DC searching, and graft biopsy. PCR-positive patients were classified as 1+, 2+, 3+. DC, viruria and viremia prevalence, sensitivity, specificity, and likelihood ratio (LR) were determined (Table 2x2). Diagnosis efficacy of DC and viruria were compared to viremia.


RESULTS
DC prevalence was 25%, viruria 61.7%, and viremia 42.5%. Positive and negative patients in each test had similar clinical, immunosuppressive, and histopathological characteristics. There was no case of viremia with chronic allograft nephropathy and, under treatment with sirolimus, patients had a lower viruria prevalence (p = 0.043). Intense viruria was the single predictive test for active infection (3+; LR = 2.8).1,6-4,9


CONCLUSIONS
DC, BKV-viruria and -viremia are commun findings under late kidney graft dysfunction. Viremia could only be predicted by intense viruria. These results should be considered under the context of BKN confirmation.
Montagner
Juliana
J
Transplant Immunology Laboratory, Santa Casa de Porto Alegre Hospital, Rua Coronel Corte Real 311/702, Petrópolis, Porto Alegre, RS, Brazil. jmontagner@mixmail.com
Michelon
Tatiana
T
Fontanelle
Barbara
B
Oliveira
Alexandre
A
Silveira
Janaina
J
Schroeder
Regina
R
Neumann
Jorge
J
Keitel
Elizete
E
Alexandre
Claudio Osmar Pereira
CO
D000328:Adult; D001739:BK Virus / Q000235:genetics / Q000302:isolation & purification*; D004279:DNA, Viral / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D016133:Polymerase Chain Reaction; D027601:Polyomavirus Infections / Q000175:diagnosis*; D015995:Prevalence; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000821:virology*; D012680:Sensitivity and Specificity; D014412:Tumor Virus Infections / Q000175:diagnosis*
D004279:DNA, Viral