title: Pilot Study of Early Monitoring Using Urinary Screening for BK Polyomavirus as a Strategy for Prevention of BKV Nephropathy in Kidney Transplantation.
abstract: BACKGROUND
  Urine monitoring programs represent an important strategy for early diagnosis of reactivation of BK polyomavirus (BKV) in kidney transplant recipients. This study analyzes a BKV urine screening model in kidney transplant patients.
  
  
  METHODS
  Urinary screening for BKV reactivation was performed by urinary decoy cell and polymerase chain reaction (PCR) tests in samples from 32 consecutive kidney transplant patients, collected in a 6-month follow-up period. PCR in plasma samples and BKV immunohistochemical studies to assess BKV renal disease, if a kidney biopsy was indicated, were performed.
  
  
  RESULTS
  The urinary screening for BKV among 32 renal receptors was positive in 18 patients (56%) by the concomitant use of the decoy cells and/or qualitative PCR at some time during the study period. Transfusion before transplantation was significantly associated with urinary decoy cell positive screening (odds ratio = 11; 95% confidence interval = 1.47 to 82.4; P < .05); and so was male sex (odds ratio = 2.02; 95% confidence interval = 1.07 to 3.83; P < .05). The clinical management of screening positive cases consisted of decreasing or changing the immunosuppression regimen. Sixteen renal biopsies were performed. Immunohistochemistry for SV40 T antigen was negative in all biopsies. After 1 year of follow-up, no patient developed BKV-associated nephropathy, and there was no difference in renal function between patients positive and negative for BKV urinary screening.
  
  
  CONCLUSIONS
  Early urinary monitoring is effective in detection of BKV replication and represents a good strategy to minimize the deleterious effects caused by the presence of the virus on preservation of graft function.
authors.affiliation: Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
authors.forename: A L F
authors.initials: AL
authors.lastname: Gouvêa
authors.affiliation: Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
authors.forename: R I J
authors.initials: RI
authors.lastname: Cosendey
authors.affiliation: Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
authors.forename: F R
authors.initials: FR
authors.lastname: Carvalho
authors.affiliation: Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
authors.forename: R B
authors.initials: RB
authors.lastname: Varella
authors.affiliation: Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
authors.forename: C F
authors.initials: CF
authors.lastname: de Souza
authors.affiliation: Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
authors.forename: P F
authors.initials: PF
authors.lastname: Lopes
authors.affiliation: Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
authors.forename: A A
authors.initials: AA
authors.lastname: Silva
authors.affiliation: Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
authors.forename: M C
authors.initials: MC
authors.lastname: Rochael
authors.affiliation: Faculdade de Ciências Médicas/Anatomia Patológica/Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: H P
authors.initials: HP
authors.lastname: de Moraes
authors.affiliation: Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
authors.forename: J R
authors.initials: JR
authors.lastname: Lugon
authors.affiliation: Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil. Electronic address: jorgereis@id.uff.br.
authors.forename: J R
authors.initials: JR
authors.lastname: Almeida
mesh_terms: D000328:Adult; D001739:BK Virus / Q000235:genetics; D001706:Biopsy; D004279:DNA, Viral / Q000652:urine*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000652:urine*; D016030:Kidney Transplantation; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D010865:Pilot Projects; D016133:Polymerase Chain Reaction; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000209:etiology / Q000652:urine*; D012737:Sex Factors; D066027:Transplant Recipients; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000209:etiology / Q000652:urine*; D016482:Urinalysis
chemical_list: D004279:DNA, Viral; D007166:Immunosuppressive Agents