title: The BK virus in renal transplant recipients-review of pathogenesis, diagnosis, and treatment.
abstract: The BK virus, a DNA virus from the Polyomavirus group, represents an opportunistic infection of immunosuppressed transplant recipients. Though the virus was discovered approximately 40 years ago, the emergence of BK virus nephropathy since 1995 onwards, with associated high graft loss rates, has revolutionized renal transplantation medicine. Kidney transplant professionals realized that the consequences of over-immunosuppression were as severe as the consequences of under-immunosuppression and we entered the era of immunosuppressive minimization. Despite this recognition, the optimal testing type for BK virus infections and frequency of testing are hotly debated. Similarly, optimal treatment strategies remain sources of intense controversy. The authors review the current strategies of screening, diagnosis, and possible treatment, and also review the amount and quality of evidence in favor or against. Similarities and differences between cytomegalovirus, Epstein-Barr virus, and BV virus, the three major viral infections in kidney transplantation, are highlighted.
authors.affiliation: Division of Pediatric Nephrology, University of Florida College of Medicine & Shands Children's Hospital, 1600 SW Archer Road, PO Box 100296/HD 214, Gainesville, FL 32610-0296, USA. vikasmd@peds.ufl.edu
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
authors.forename: Husam A
authors.initials: HA
authors.lastname: Abdulnour
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Araya
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus; D002648:Child; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007555:Isoxazoles / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000502:physiology*; D000077339:Leflunomide; D063065:Organophosphonates / Q000627:therapeutic use; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000473:pathology / Q000628:therapy* / Q000821:virology; D012086:Reoperation; D017211:Treatment Failure
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D063065:Organophosphonates; D003596:Cytosine; D000077339:Leflunomide; D000077404:Cidofovir