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Polyomavirus nephropathy: morphology, pathophysiology, and clinical management
Volker Nickeleit1, Harsharan K Singh, Michael J Mihatsch
1Department of Pathology, Nephropathology Laboratory, The University of North Carolina, Chapel Hill, North Carolina 27599-7525, USA. volker_nickeleit@med.unc.edu
Current Opinion in Nephrology and Hypertension
|October 18, 2003
Summary
BK-virus nephropathy is a significant post-renal transplant complication. Early detection using quantitative viral load measurements and revised management strategies, including adjusted immunosuppression and antiviral drugs, improve graft survival.
Area of Science:
- Nephrology
- Virology
- Transplantation Immunology
Background:
- BK-virus nephropathy (BKVN) is a major cause of renal allograft dysfunction.
- Post-transplant immunosuppression regimens, particularly tacrolimus and mycophenolate mofetil, increase BKVN risk.
- BKVN presents with viral replication in tubular cells, leading to acute tubular injury and potential graft loss.
Purpose of the Study:
- To review the morphological, pathophysiological, and clinical aspects of BKVN.
- To discuss current and emerging patient management strategies for BKVN.
- To highlight recent advances in diagnosing and treating viral nephropathies post-renal transplantation.
Main Methods:
- Review of current literature on BK-virus nephropathy.
- Analysis of diagnostic advancements, including real-time quantitative PCR for viral load.
- Evaluation of therapeutic strategies, including immunosuppression modulation and antiviral agents.
Main Results:
- Immunosuppression is a key risk factor for BKVN activation.
- Concurrent acute rejection episodes worsen BKVN outcomes.
- Quantitative viral load monitoring enables timely clinical intervention.
- Antiviral therapies (cidofovir, leflunomide) and immunosuppression adjustment improve graft survival.
- Re-transplantation is an option following graft loss due to BKVN.
Conclusions:
- BKVN remains a significant threat to renal transplant recipients.
- Advances in understanding BKVN pathogenesis and risk factors are crucial.
- Optimized patient management, guided by quantitative viral load measurements, enhances graft outcomes.