title: Management of BK virus nephropathy in kidney transplant recipients at the Royal Hospital - Clinical Audit - Oman.
abstract: OBJECTIVE
  Nephropathy from BK virus (BKV) infection is a growing challenge in kidney transplant recipients globally. It is the result of contemporary potent immunosuppressives aimed at reducing acute rejection and improving allograft survival. Untreated BK virus infections lead to kidney allograft dysfunction or loss. Decreased immunosuppression is the principle treatment but predisposes to acute and chronic rejection. Screening for early detection and prevention of symptomatic BK virus nephropathy may improve outcomes. Although no approved antiviral drug is available, leflunomide, cidofovir, quinolones, and intravenous immunoglobulin have been used. Since the introduction of the new immunosuppressive agents in the transplant regimen at the Royal Hospital, Few cases of BK virus have been detected, and the challenge was to decide upon the best treatment option.
  
  
  METHODS
  The audit was carried out at the Royal Hospital-Oman between January 2010 and December 2012. The nephrology consultant and the clinical pharmacist reviewed all the BK cases and the Royal Hospital. Extensive literature review carried out by the pharmacist to look into the prevalence, prognosis and treatment of BK nephropathy. A treatment protocol was prepared by the clinical pharmacist through guidance of the consultant and was peer reviewed by team of clinical pharmacists and nephrology doctors and approved by the consultant.
  
  
  RESULTS
  The audit included 19 patients with positive BK virus ployoma nephropathy. The treatment options were applied stepwise in all the patients with BK virus nephropathy with success rate more than 70%.
  
  
  CONCLUSIONS
  BK virus nephropathy is emerging at an alarming rate and requires increasing awareness. The uses of current treatment options are still questionable. Our audit confirms that reducing immunosuppression appears to be the criterian standard for the treatment of BK nephropathy.
authors.affiliation: From the Department of Nephrology, Royal Hospital, Muscat, Oman.
authors.forename: Fatma
authors.initials: F
authors.lastname: Al-Raisi
authors.forename: Nabil
authors.initials: N
authors.lastname: Mohsin
authors.forename: Pramod
authors.initials: P
authors.lastname: Kamble
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001739:BK Virus / Q000276:immunology / Q000472:pathogenicity*; D002648:Child; D005260:Female; D006761:Hospitals; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009850:Oman / Q000453:epidemiology; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D010348:Patient Care Team; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents