High-level viruria as a screening tool for BK virus nephropathy in renal transplant recipients.
BACKGROUND
Although early monitoring of BK virus infection in renal transplant patients has led to improved outcomes over the past decade, it remains unclear whether monitoring for viremia is the best screening tool for BK virus nephropathy (BKVN).


METHODS
We conducted a retrospective review of the medical records of 368 renal transplant recipients who had a minimum of 18 months of posttransplantation follow-up. The relationship between the presence of BK viruria and a composite end point of BK viremia/BKVN was established, and the predictive value of high-grade BK viruria for development of viremia/BKVN was determined.


RESULTS
High grade of BK viruria was present in 110 (30.1%) of the renal transplant recipients. BK viremia/BKVN was present in 64 (17.4%) patients and was 50 times more likely to be present in patients with high-grade BK viruria. The risk of developing BK viremia/BKVN was 3 times higher in high-grade viruria patients, and viruria preceded viremia by nearly 7 weeks.


CONCLUSIONS
The presence of high-grade viruria is an early marker for developing BK viremia/BKVN. Detection of high-grade viruria should prompt early allograft biopsy and/or preemptive reduction in immunosuppression.
Division of Nephrology & Hypertension, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
W James
WJ
Chon
Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA.
Nidhi
N
Aggarwal
Department of Health Studies, University of Chicago, Chicago, IL, USA.
Masha
M
Kocherginsky
Section of Transplantation, Department of Surgery, University of Chicago, Chicago, IL, USA.
Brenna
B
Kane
Section of Transplantation, Department of Surgery, University of Chicago, Chicago, IL, USA.
Jozefa
J
Sutor
Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA.
Michelle A
MA
Josephson
BK virus; BK virus nephropathy; Renal transplant; Viruria
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