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[Polyomavirus nephropathy: pathogenesis, morphological and clinical aspects].
1Department of Pathology, Nephropathology Laboratory, The University of North Carolina, Chapel Hill, North Carolina 27599-7525, USA.
Verhandlungen Der Deutschen Gesellschaft Fur Pathologie
|August 9, 2006
Summary
Polyoma-BK-virus (BK) infection is now the most common complication in kidney transplant recipients, leading to graft dysfunction and loss. Early diagnosis and understanding of BK-associated nephropathy (BKN) are crucial for patient management.
Area of Science:
- Nephrology
- Virology
- Immunology
Context:
- Introduction of novel immunosuppressive drugs in the 1990s increased BK-virus (BK) infections in renal transplant recipients.
- Polyoma-BK-virus (allograft) nephropathy (BKN) is the most prevalent infection in kidney allografts, affecting 1-10% of recipients worldwide.
- BKN can cause chronic allograft dysfunction and graft loss in over 50% of cases.
Purpose:
- To detail the increasing clinical significance of BKN in renal allograft recipients.
- To describe the pathogenesis, histological features, and diagnostic methods for BKN.
- To highlight the pathologist's role in managing BKN and differentiating it from acute rejection.
Summary:
- BKN results from reactivation of latent BK virus under intensive immunosuppression, leading to productive viral replication within the kidney allograft.
- Histological hallmarks include intranuclear viral inclusion bodies in tubular and glomerular cells, with distinct variants described.
- Diagnostic approaches include urine cytology for decoy cells, plasma PCR, and graft biopsies, aiding in timely intervention.
Impact:
- Understanding BKN pathogenesis and histological manifestations is vital for improving patient outcomes and graft survival.
- Accurate diagnosis and monitoring of BKN, alongside distinguishing it from acute rejection, are critical for effective immunosuppressive therapy adjustment.
- The pathologist plays a key role in early BKN detection and patient management through various diagnostic techniques.