BK Virus-Associated Nephropathy with Plasma Cell-Rich Infiltrates Treated by Bortezomib-Based Regimen.
BK virus infection accompanied with plasma cell-rich infiltrates is a dilemma in renal transplant recipients. One young female patient diagnosed as BK virus-associated nephropathy with plasma cell-rich infiltrates at 16 months after renal transplant was treated with bortezomib and a sequential immuno-suppressive protocol of tacrolimus combined with leflunomide. After a short period of reduction, her serum creatinine increased slowly with stable BK viruria. The patient underwent repeat biopsy. The histologic changes showed a decrease in plasma cells and CD20+ cells in the allograft, but the other mononuclear cells showed no difference from the first biopsy. The immunosuppressive protocol was converted to tacrolimus combined with enteric-coated mycophenolate sodium. Her serum creatinine decreased gradually during 6 months of follow-up. We speculate that bortezomib can be used in BK virus-associated nephropathy accompanied with plasma cell-rich infiltrates, and this effect might be mediated through a decrease of plasma cells and CD20+ cells in the allograft. The dosage and time of therapy need to be explored in the future; additional studies of large samples are needed.
From the National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province; and the Department of Urology, Xuancheng People's Hospital, Xuancheng, Anhui Province, China.
Di
D
Wu
Ming-chao
MC
Zhang
Jin-song
JS
Chen
Xue
X
Li
Dong-rui
DR
Cheng
Ke-nan
KN
Xie
Shu-ming
SM
Ji
Zhi-hong
ZH
Liu
Ji-qiu
JQ
Wen
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001739:BK Virus; D000069286:Bortezomib / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D007674:Kidney Diseases / Q000188:drug therapy* / Q000473:pathology*; D016030:Kidney Transplantation; D000077339:Leflunomide; D010950:Plasma Cells / Q000473:pathology*; D027601:Polyomavirus Infections / Q000188:drug therapy* / Q000473:pathology*; D011183:Postoperative Complications / Q000188:drug therapy; D016559:Tacrolimus / Q000627:therapeutic use; D014412:Tumor Virus Infections / Q000188:drug therapy* / Q000473:pathology*
D000970:Antineoplastic Agents; D007555:Isoxazoles; D000069286:Bortezomib; D000077339:Leflunomide; D016559:Tacrolimus