BK virus nephritis after renal transplantation

• Published in: Kidney international Vol. 69; no. 4; pp. 655 - 662
• Main Author: Hariharan, S.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2006; Nature Publishing; Elsevier Limited
• Subjects: Antibodies, Viral; Antiviral Agents - therapeutic use; Biological and medical sciences; BK Virus - genetics; BK Virus - immunology; BK Virus - isolation & purification; BK Virus - physiology; BKV-nephritis; Cytosine - analogs & derivatives; Cytosine - therapeutic use; diagnosis; DNA, Viral - blood; DNA, Viral - urine; Graft Survival - immunology; Humans; Immunity, Cellular; Immunosuppressive Agents - adverse effects; Isoxazoles - therapeutic use; Kidney - pathology; Kidney - physiopathology; Kidney - virology; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Medical sciences; Nephritis - blood; Nephritis - epidemiology; Nephritis - etiology; Nephritis - virology; Nephrology. Urinary tract diseases; Organophosphonates - therapeutic use; pathogenesis; Polyomavirus Infections - blood; Polyomavirus Infections - drug therapy; Polyomavirus Infections - epidemiology; Polyomavirus Infections - etiology; Prevalence; renal transplantation; Risk Factors; treatment; Treatment Outcome; Tumor Virus Infections - blood; Tumor Virus Infections - drug therapy; Tumor Virus Infections - epidemiology; Tumor Virus Infections - etiology; Viremia - drug therapy; Viremia - epidemiology; Viremia - etiology; Viremia - urine; BKV-nephritis; treatment; pathogenesis; diagnosis; renal transplantation; Kidney disease; Nephritis; Nephrology; Urinary system disease; Pathogenesis; Polyomavirus; Transplantation; BK virus; Papovaviridae; Urology; Infection; Virus; Nephropathy; Treatment; Surgery; Viral disease; Graft; Diagnosis
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/sj.ki.5000040

BK viremia and nephritis are increasing problems in renal transplant recipients. The exact cause of the increasing prevalence of this condition remains poorly understood. Increasing prevalence has been correlated with newer immunosuppressive agents and the decline in acute rejection rates in recent years. The clinical manifestation varies from the asymptomatic state of viremia and nephritis to clinical renal dysfunction. The diagnosis of this infection is based on the combination of the presence of urinary decoy cells, virus in the urine/blood, and typical renal histological findings of interstitial nephritis. Routine post-transplant screening for BK viremia and viruria prior to the occurrence of nephritis and the reduction in immunosuppressive therapy for subjects with viremia appear to be attractive approaches. The treatment of BKV nephritis (BKVN) consists of reduction in immunosuppressive therapy and antiviral therapy with cidofovir or leflunomide or a combination of both. Approximately 30–60% of subjects with BKVN experienced irreversible graft failure. However, in recent years, the combinations of early detection, prompt diagnosis, and appropriate reduction in immunosuppressive therapy have been associated with better outcome. The pathogenesis of BK virus infection in renal transplant recipients needs to be explored. The source of BKV infection (donor as opposed to recipient), the role of host humoral, and cellular immunity to BKV, and the role of alloimmune activation in renal graft to the occurrence of nephritis are discussed in this review.