title: The Noninvasive Urinary Polyomavirus Haufen Test Predicts BK Virus Nephropathy in Children After Hematopoietic Cell Transplantation: A Pilot Study.
abstract: After hematopoietic cell transplantation (HCT), polyoma-BK virus is associated with hemorrhagic cystitis and also with polyomavirus nephropathy (PVN). However, the true burden of post-HCT PVN is unknown because kidney biopsies are avoided due to their bleeding risk. The novel, noninvasive urinary PV-Haufen test detects PVN in kidney transplant recipients with greater than 95% positive/negative predictive values. We hypothesized that the detection of PV-Haufen in voided urine samples-a positive PV-Haufen test-was also clinically significant after HCT.
  
  
  
  We examined 21 suitable urine samples from 14 patients (median age, 15 years; 71.4% male) who were selected from repositories for having varying degrees of BK viremia (range, 0-1.0 × 10 copies/mL), hemorrhagic cystitis (present/absent), and data on kidney function. Urine samples were obtained at a median of 88 days post-HCT.
  
  
  
  The PV-Haufen were detected in 5 of 14 patients (35.7%) and 7 of 21 (33.3%) urine samples, with histologic confirmation of PVN in 1 autopsy specimen. After a median of 285 days post-HCT, patients with PV-Haufen had an increased risk of dialysis-dependent renal failure (P < 0.05). All 3 dialysis-dependent patients had PV-Haufen and died. The presence of urinary PV-Haufen was not significantly correlated with hemorrhagic cystitis. From the 16 urines collected during BK viremia, 43.8% were PV-Haufen-positive, and 56.2% were negative. The PV-Haufen were not present in the 5 urines from patients without concomitant BK-viremia.
  
  
  
  In this proof-of-concept study, a positive PV-Haufen test was only seen in some patients with BK viremia and was not associated with hemorrhagic cystitis. The detection of PV-Haufen suggests underlying PVN with an increased risk of kidney failure and dialysis.
authors.affiliation: 1 Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA. 2 Division of Nephropathology, Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC. 3 Divsion of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA. 4 Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5 Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 6 Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Laskin
authors.forename: Harsharan K
authors.initials: HK
authors.lastname: Singh
authors.forename: Ulf H
authors.initials: UH
authors.lastname: Beier
authors.forename: Taylor
authors.initials: T
authors.lastname: Moatz
authors.forename: Susan L
authors.initials: SL
authors.lastname: Furth
authors.forename: Nancy
authors.initials: N
authors.lastname: Bunin
authors.forename: David
authors.initials: D
authors.lastname: Witte
authors.forename: Jens
authors.initials: J
authors.lastname: Goebel
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
authors.forename: Christopher
authors.initials: C
authors.lastname: Dandoy
authors.forename: Sonata
authors.initials: S
authors.lastname: Jodele
authors.forename: Volker
authors.initials: V
authors.lastname: Nickeleit
mesh_terms: D000293:Adolescent; D000328:Adult; D001739:BK Virus / Q000302:isolation & purification*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis*; D008297:Male; D010865:Pilot Projects; D027601:Polyomavirus Infections / Q000175:diagnosis*; D014412:Tumor Virus Infections / Q000175:diagnosis*; D017201:Virus Shedding