In case of immunodeficient hosts, jcv can lytically infect the oligodendrocytes, causing a fatal demyelinating disease, known as progressive multifocal leukoencephalopathy pml. Polyomavirusassociated nephropathy presenting late after. Bk virus nephropathy american society of nephrology. During the last decade, polyomavirus associated nephropathy pvan has emerged as an important cause of allograft failure following renal transplantation. Bk polyomavirus bkv is an emerging pathogen in immunocompromised individuals.
A substantial proportion of renal transplant failures can be attributed to polyomavirus bkassociated nephropathy pvan. Bk polyomavirus nephropathy in two kidney transplant. Bk virus bkv is the primary etiologic agent, but jc virus jcv and possibly simian virus sv40 may account for some cases. In the last 10 years, better immunosuppression drugs have decreased the rates of acute rejection in kidney transplantation but have also led to the emergence of polyomavirus associated nephropathy pvan. Dec 24, 2012 polyomavirus associated nephropathy pvan is one of the most common viral complications in renal transplant recipients and is an increasingly recognized cause of renal transplant dysfunction and graft loss. Merkur university hospital, zagreb, croatia 2 department of urology. In recent years, the widespread use of realtime pcr for measuring viral loads has confirmed that bk viruria and. Polyomavirus infection is an emerging challenge wherein nephritis and graft loss may affect up to 10% of kidneytransplant recipients. Polyomavirusassociated nephropathy pvan is common in patients who have undergone kidney transplantation and has been reported in hematopoietic stem cell hsc transplant recipients. The histological diagnosis of bk or jc polyomavirus allograft nephritis pvan requires evaluation of a renal biopsy with demonstration of the polyomavirus cytopathic changes and confirmation with an ancillary. The rate of pvan was determined over an univariate and multivariate analysis over an average of 30 months of followup of patients receiving predominantly living. Despite great progress in the field of renal transplantation, infectious complications remain a significant cause of morbidity and mortality. Leflunomide and polyomavirusassociated nephropathy in. Polyomavirus associated nephropathy after kidney and pancreas.
Polyomavirusassociated nephropathy open access omics. Antiviral therapy for polyomavirusassociated nephropathy. Bk polyomavirus bkpyv causes premature graft failure in 1 to 15% of kidney transplant kt recipients. The prevalence of pvan is estimated to be 110% and has shown a stepwise increase in the past decade 35.
Bk virusassociated nephropathy is a relevant topic in the new era of. Polyomavirusassociated nephropathy pvan is an emerging cause of kidney transplant failure affecting 110% of patients. Clinical and pathological study of polyomavirusassociated nephropathy after renal transplantation ji shuming1, xie kenan 1, chen jinsong 1, wen jiqiu, cheng dongrui, li xu, ni xuefeng and liu zhihong2 1national clinical research center of kidney diseases, jinling hospital, china 2nanjing university school of medicine, china corresponding author. We studied 70 kidney recipients in the renal transplant unit of dr. Polyomavirus associated nephropathy pvan is diagnosed in a 36yearold woman who had a deceaseddonor renal transplant. There should be a high index of suspicion about this disease, although the incidence is only between 2% and 5% as the future of renal graft depends on the early and appropriate management of the same. Although discovered in 1970 the bk virus infections had no significant clinical impact until the emergence of bk virusassociated allograft nephropathy bkpvan. Highlevel bkpyvviruria and bkpyvdnaemia precede polyomavirusassociated nephropathy pyvan, and guide clinical management decisions. Blood and urine polymerase chain reaction testing allows invasive investigation i.
An example of histologic injury due to polyomavirusassociated nephropathy pvan on a surveillance renal allograft biopsy. Hirsch3,7, karsten midtvedt8 and christine hanssen rinaldo1,2. Clinical and pathological study of polyomavirusassociated nephropathy after renal transplantation abstract. Pvan has not attracted the attention of clinical transplant physicians over the years. We report a case of pvan in a severely immunocompromised allogeneic hsc transplant recipient that was treated with. Highlevel bkpyvviruria and bkpyvdnaemia precede polyomavirus associated nephropathy pyvan, and guide clinical management decisions. Polyomavirus associated nephropathy pvan is a frequent cause of kidney transplant failure. Polyomavirusassociated nephropathy pvan is one of the most common viral complications in renal transplant recipients. We determined the risk factors for biopsyproven pvan among 1027 recent kidney transplant recipients by univariate and multivariate analyses. Histologic versus molecular diagnosis of bk polyomavirus. Histological evolution of bk virus associated nephropathy. Polyomavirusassociated nephropathy pvan has recently emerged as an important. Escalating clinical challenges required better diagnostic tools and delineation of uniform criteria for diagnosis. Pvan is an inflammatory disease that occurs after renal transplantation and is characterized by viral inclusions, interstitial nephritis, and progressive allograft failure.
Bk polyoma virus this virus is a member of the polyomavirus family. But with the advent of heightened clinical suspicion and improved diagnostics the prognosis has improved considerably. Moreover, uncertainty about diagnostic procedures and paucity of effective interventions contribute to the high rate of graft loss among renal transplant recipients with pvan. Polyomavirusassociated nephropathy pvan is one of the most serious complications after renal transplantation. Bk virus presents as bk virus nephropathy and has, in rare instances, been associated with hemorrhagic cystitis or ureteral. Bk is the most important virus associated with this condition, though rare cases of the jc virus or sv40 associated nephropathy have been reported. The top open access journals are freely available on the public internet domain. Molecular genotyping of bk and jc viruses in human polyomavirusassociated interstitial nephritis after renal transplantation. Bk polyomavirusassociated nephropathy is an important cause of posttransplantation renal failure. A multicenter application of the 2018 banff classification for bk polyomavirus associated nephropathy in renal transplantation.
Clinical and pathological study of polyomavirus associated nephropathy after renal transplantation ji shuming1, xie kenan 1, chen jinsong 1, wen jiqiu, cheng dongrui, li xu, ni xuefeng and liu zhihong2 1national clinical research center of kidney diseases, jinling hospital, china 2nanjing university school of medicine, china. Using a mouse polyomavirus mpyv kidney transplant model, we investigated clinically. Critical issues of screening and management polyomavirusassociated nephropathy pvan is an emerging disease in renal. The rate of pvan was determined over an univariate and multivariate analysis over an average of 30 months of followup of patients receiving predominantly. The polyomavirus pyv, jc virus jcv, is a small nonenveloped dna virus that asymptomatically infects about 80% of healthy adults and establishes latency in the kidney tissue. This occurs in 1% to 10% of patients with kidney transplantion and is caused by bk virus in more than 95% of cases.
Polyomavirus associated nephropathy pvan is one of the most serious complications after renal transplantation. Antiviral therapy for polyomavirusassociated nephropathy after. Bk is the most important virus associated with this condition, though rare cases of the jc. May 24, 2017 bk polyomavirus associated nephropathy is an important cause of post transplantation renal failure. Pvan, often diagnosed within 12 months of transplant, developed 8 years later.
Case 1 is a 37yearold white man whose graft had never presented a good glomerular. The classification, diagnosis, and treatment of acute renal allograft rejection, chronic renal allograft. Polyoma virus nephropathy in kidney transplantation. Reduction or adjustment in immunosuppression remains the cornerstone for the treatment and prevention of polyomavirus associated nephropathy. A substantial proportion of renal transplant failures can be attributed to polyomavirus bk associated nephropathy pvan. Human polyomaviruses pvs, including jc jcv and bk bkv, are known to cause polyomavirusassociated nephropathy pvan in 2% to 5% of renal transplant recipients in the past decade. Management of polyomavirusassociated nephropathy in renal.
This infection carries a poor prognosis with reported renal allograft loss from 10% to 80%. Renal transplantation became feasible in the early 1960s when a combination of azathioprine and steroids was proved to be successful in suppressing the immune response. We present two cases of bk polyomavirus associated nephropathy who were submitted to contrasting strategies of clinical followup to bk polyomavirus reactivation, but progressed to a similar final outcome. Nephropathy is most common early after transplant when immunosuppression is at its peak. An example of histologic injury due to polyomavirus associated nephropathy pvan on a surveillance renal allograft biopsy. Understanding the pathogenesis of polyomavirusassociated allograft nephropathy pvan is hampered by the species specificity of polyomaviridae family members.
The histological diagnosis of bk or jc polyomavirus allograft nephritis pvan requires evaluation of a renal biopsy with demonstration of the polyomavirus cytopathic changes and confirmation with an. There is no consensus definition for allograft dysfunction following kidney transplant. Brincidofovir for polyomavirusassociated nephropathy. Bk and other polyomaviruses in kidney transplantation seminars. Pdf leflunomide and polyomavirus associated nephropathy. More than 95% of all cases are caused by the human polyomavirus type 1 called the bk virus.
Jan 10, 2020 bk polyomavirus bkpyv causes premature graft failure in 1 to 15% of kidney transplant kt recipients. In the second case, leucopaenia was detected in an asymptomatic patient 6 months after transplantation. Screening for polyomavirus associated nephropathy in renal. Shortly thereafter, renal transplant recipients were shown to have a high incidence of viral infections, mainly as a result of cytomegalovirus cmv and other herpes viruses. The human polyomavirus type 1, the bk virus bkv, is the underlying etiologic agent in practically all cases. Polyomavirusassociated nephropathy in renal transplantation. Human polyomaviruses pvs, including jc jcv and bk bkv, are known to cause polyomavirus associated nephropathy pvan in 2% to 5% of renal transplant recipients in the past decade. Jan 16, 2015 polyomavirus associated nephropathy pvan is common in patients who have undergone kidney transplantation and has been reported in hematopoietic stem cell hsc transplant recipients. Importance of integrating clinical and pathological findings.
Polyomavirus associated nephropathy after kidney and. In the last 10 years, better immunosuppression drugs have decreased the rates of acute rejection in kidney transplantation but have also led to the emergence of polyomavirusassociated nephropathy pvan. Request pdf polyomavirusassociated nephropathy in renal transplantation. Polyomavirus associated nephropathy pvan has recently emerged as an important cause of allograft failure following renal transplantation. High incidence of malignancy in polyomavirusassociated. Because the reconstitution of the immune system in the control of infection takes 4 to12 weeks, it is imperative to start treatment as early as possible. A renal allograft surveillance biopsy at 1year posttransplant demonstrates dense interstitial mononuclear infiltration and cytopathic changes of multiple tubular epithelial cells suggestive of pvan large arrows.
Nephropathy associated with bk polyomavirus bkv causes kidney allograft dysfunction and failure. Bk virusassociated nephropathy in kidney transplant. Baishideng publishing group inc, 7041 koll center parkway, suite 160, pleasanton, ca 94566, usa. Polyomavirusassociated nephropathy pvan is diagnosed in a 36yearold woman who had a deceaseddonor renal transplant. During the last decade, polyomavirusassociated nephropathy pvan has emerged as an important cause of allograft failure following renal transplantation. The increase in prevalence data could be due to the introduction of new deeply immunosuppressive drugs andor the relative decline in acute rejection rates. Prior to its recognition as a separate entity, kidney transplant infection with the polyoma virus, bk virus bkv, and the ensuing viral nephropathy bkvn portended a poor prognosis. In a kaplanmeier analysis of graft survival in renal transplant recipients with polyomavirus. Bk virusassociated nephropathy bkvn is an important cause of allograft dysfunction in renal transplantation. Infection of the immunosuppressed kidney results in a pathological condition called bk polyomavirus nephropathy. Bkv infection occurs in 19 % of renal transplants and causes chronic nephropathy or graft loss.
Moreover, uncertainty about diagnostic procedures and paucity of effective interventions contribute to the high rate of graft loss among renal. Polyomavirusassociated nephropathy pvan is a frequent cause of kidney transplant failure. Intense immunosuppression is viewed as the most important risk factor. We present two cases of bk polyomavirusassociated nephropathy who were submitted to contrasting strategies of clinical followup to bk polyomavirus reactivation, but progressed to a similar final outcome. Histological evolution of bk virusassociated nephropathy. There is no specific therapy for bkvn, although reducing immunosuppression to decrease viral load has been the first step in most cases. Despite decreasing immunosuppressive medications being the cornerstone of treatment, the protocols and responsive rates are. Diagnosis of bkvassociated nephropathy bkvan is based on detection of viruria then viremia and at least a tubuleinterstitial nephritis at renal biopsy.
Influence of surveillance renal allograft biopsy on diagnosis and prognosis of polyomavirus associated nephropathy. Early fulminant bk polyomavirusassociated nephropathy in two. Apr 17, 2012 polyomavirusassociated nephropathy pvan is an important infectious complication after renal transplantation, affecting 110% of recipients and causing graft loss in approximately 50% of cases. Polyomavirusassociated nephropathy pvan is an important infectious complication after renal transplantation, affecting 110% of recipients and. Aside from reduction of immunosuppression, few therapeutic options exist for treatment of pvan. Polyomavirus associated nephropathy pvan is an emerging disease in renal transplant patients with variable prevalence of 110% and graft loss up to 80%. Clinical and pathological study of polyomavirusassociated.
Mycophenolate mophetil dosage was reduced but renal allograft function deteriorated, and a kidney biopsy revealed polyomavirus associated nephropathy, also with. Bk polyomavirus nephropathy in two kidney transplant patients. It usually does not cause any infection and is relatively asymptomatic. Drachenberg cb, papadimitriou jc, chaudhry mr, et al. Early fulminant bk polyomavirusassociated nephropathy in. Pvan is diagnosed in 110% of kt patients 2, 3, with the majority of cases occurring toward the end of the first year post. Reducing immunosuppression is the key treatment option, but addition of leflunomide may improve bk virus bkv clearance and graft survival. The decade of polyomavirus bkassociated nephropathy. We report a case of pvan in a severely immunocompromised allogeneic hsc transplant. Understanding the pathogenesis of polyomavirus associated allograft nephropathy pvan is hampered by the species specificity of polyomaviridae family members. Polyomavirus associated nephropathy pvan is caused by bk virus bkv and has emerged in the last decade as a major cause of allograft failure in renal transplant recipients. Here we provide the wholegenome sequence of a subtype iii bkv from a pediatric kidney transplant patient with polyomavirusassociated nephropathy. Bk virusassociated nephropathy in kidney transplant recipients.
Renal biopsy findings were consistent with polyomavirus associated nephropathy. Polyomavirusassociated nephropathy pvan is an emerging disease in renal transplant patients with variable prevalence of 110% and graft loss up to 80%. Diagnosis and treatment of bk virusassociated transplant. Brincidofovir for polyomavirusassociated nephropathy after. Infection with polyomavirus bk virus is the cause of renal graft losses in more than 50% of the infected cases. Polyomavirusassociated nephropathy pvan has become an important cause of allograft dysfunction in renal transplantation, but only limited information is available regarding its pathogenesis. Since the first description of pvan in 1995, an increasing prevalence rate from 1% to 10% has been evidenced. Ultrasound findings of bk polyomavirusassociated nephropathy. This report and the description of four new cases 29,30had signi. The use of immunosuppressive medications in these individuals allows this virus to replicate within the graft resulting in bk polyomavirus nephropathy. Leflunomide and polyomavirus associated nephropathy in renal. Bkv subtype iii is rarely identified and has not previously been associated with disease. Monitoring of bk virus in transplant patients of the renal unit of the.
There should be a high index of suspicion about this disease, although the incidence is only between 2% and 5% as the future of renal graft depends on the early and appropriate management of. Polyomavirus associated nephropathy pvan has become an important cause of allograft dysfunction in renal transplantation, but only limited information is available regarding its pathogenesis. Bk virus nephropathy is a serious complication of kidney transplantation. Polyomavirusassociated nephropathy in renal and simultaneous. Over 60% of the population is infected with bkv by early childhood. Polyomavirusassociated nephropathy pvan is one of the most common viral complications in renal transplant recipients and is an increasingly recognized cause of renal transplant dysfunction and graft loss. In most cases, bkpyv appears to come from the donor kidney, but data from biopsyproven pyvan cases are lacking. Bk polyomavirus in solid organ transplantation wiley online library.
Influence of surveillance renal allograft biopsy on. Influence of surveillance renal allograft biopsy on diagnosis. A multicenter application of the 2018 banff classification for bk polyomavirusassociated nephropathy in renal transplantation. Polyomavirus bk typeassociated nephropathy pvan has increasingly been noted as a significant cause of graft dysfunction or failure 12. Polyomavirus continues to represent a formidable challenge in kidney transplantation. Leflunomide and polyomavirusassociated nephropathy in renal transplant nefro 234 dd 349 nefro 234 dd 349 08102009 17. Jan 28, 2019 bk polyomavirus nephropathy is usually found in individuals who have undergone a renal transplant. Although 10%30% of kidney recipients have bk viremia, nephropathy occurs in approximately 2% 11. The primary treatment for pvan is immunosuppression reduction, which must be carefully balanced.