Fish for bk viral nephropathy cleveland clinic laboratories. Jc and bk virus infection is very prevalent in the first 2 years after kidney transplant j res med sci 2011. Bk virus bkv dna quantification is based upon the realtime pcr amplification and detection of bkv genomic dna. Bk virus bkv is a major causative agent of nephropathy in kidney transplant recipients. This is called latent, or like being asleep in your body. Bkn causes severe graft dysfunction and contributes to graft loss 35. Bk virus nephropathy university of tennessee health science. Bkvirus nephropathy bkn, is an unusual complication that has recently been described. Bk virus bkv infection represents a serious complication in renal transplant patients resulting in bkvassociated nephropathy and subsequent allograft loss. To elucidate whether killercell immunoglobulinlike receptors and.
Bk virus nephropathy in renal transplant recipients. Lager, md1 the bk virus is a ubiquitous member of the group of human polyoma viruses that commonly is. Fish for bk viral nephropathy background bk viral nephropathy is a not infrequent complication of the immunosuppression required for successful renal transplantation. The bk virus is a member of the polyomavirus family. The major diseases caused by bkv are tubulointerstitial nephritis and ureteral stenosis in renal transplant recipients and hemorrhagic cystitis in bone marrow transplant recipients. Acute rejection and different viral infections should be considered in differential diagnosis of renal allograft dysfunction. At a median of 32 weeks posttransplantation, bk virus was detected in serum samples from all 4 cases, but from none of the control patients. Bk virus is an abbreviation of the name of the first patient whom the virus was isolated from in 1971 the patient was then 29 years old. The first sign of reactivation is bk viruria, which has been reported in 1560% of kidney transplant patients. Quantitation of bk virus load in serum for the diagnosis of bk virusassociated nephropathy in renal transplant recipients. If you continue browsing the site, you agree to the use of cookies on this website.
Recognition of bk viral nephropathy is essential to the successful management. Bk virus nephropathy in the native kidneys of a pediatric. Urinary exosomal viral microrna as a marker of bk virus. Bk virus nephropathy in the native kidneys of a pediatric heart transplant recipient polyoma virus nephropathy is recognized as an important cause of allograft dysfunction and graft loss in pediatric and adult renal transplant recipients 1, 2. Infection of the immunosuppressed kidney results in a pathological condition called bk polyomavirus nephropathy. Control patients were 16 transplant recipients who did not develop bk virusassociated nephropathy. Bk virus nephropathybk virus nephropathy slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Bk virus associated nephropathy occurring in association with human immunodeficiency virus infection and acquired immunodeficiency syndrome aids was reported only rarely. Incidence of bk virus nephropathy bkvn in renal transplant recipients article pdf available in international journal of organ transplantation medicine 33. At bk polyoma virus nephropathy diagnosis, all patients had decreased renal function with glomerular filtration rate median 29 mlmin1. Bk virusassociated renal problemsclinical implications.
Additionally, risk factors associated with the pro1division of nephrology, department of internal medicine. Polyomavirus bk virus bkv is small doublestranded dna virus that has been assigned to the polyomaviridae family, which includes the jc virus jcv and the simian virus sv40. The humanbk polyomavirus bkv is linked to two major complications in. The genetic predisposition of natural killer cell to bk.
Nephropathy jeopardizes graft function, causing a premature failure of the graft in 1%10% of patients with kidney transplants. Bk virus nephropathy american society of nephrology. We strongly recommend that you talk with a trusted healthcare. It usually does not cause any infection and is relatively asymptomatic. Bk virus, kidney, nephropathy, polyoma, transplantation. Pdf incidence of bk virus nephropathy bkvn in renal. Recognition of bk viral nephropathy is essential to. Interstitial nephritis associated to infection by polyomavirus subtype bk bkv is a significant and growing problem in renal transplant recipients. Bk virus has been associated with 3 major clinical syndromes as follows. Bk is a circular, doublestranded dna virus from the polyomavirus family, which includes jc virus and sv40. Bk virus bkv, a human polyomavirus, infects most of the human population, but clinically relevant infections are usually limited to individuals who are immunosuppressed. Bkv nephropathy is now a leading cause of chronic kidney disease and early allograft failure following kidney transplantation. Bk virusinduced allograft nephropathy may be more common in patients who are treated with certain immunosuppressive regimens. The detection of polyomavirus dna was carried out in serum and urine samples of 165 potential kidney donors.
Bk polyoma virus nephropathy was diagnosed at a median of 267 days after hematopoietic cell transplant range, 3637. Bk is the most frequent pathogenic agent of polyomavirus nephropathy bkvn in kidney transplant patients, which is only exceptionally caused by jc virus. Bk virus nephropathy polyomavirus adding insult to. Polyoma virus nephropathy in kidney transplantation. Risk factors in the progression of bk virusassoci ated. Bk polyoma virus this virus is a member of the polyomavirus family. Jan 28, 2019 bk polyomavirus nephropathy is usually found in individuals who have undergone a renal transplant. Brennan department of internal medicine, washington university school of medicine, st. Hmiel2 1driscoll childrens hospital, kidney center, corpus christi, texas, usa 2washington university school of medicine, division of pediatric nephrology, st louis, missouri, usa. It is the consequence of modern potent immunosuppression aimed at reducing acute rejection and improving allograft survival. An association between bk virus replication in bone marrow.
Bressollettebodin c, costeburel m, hourmant m, et al. Intravenous immunoglobulin in bk virus nephropathy elizabeth i. As primary infection occurs in childhood, bkv may be particularly important in the. Bk virus screening and management following kidney. After primary infection, bkv remains latent in the kidneys and can be reactivated in immune deficiency conditions, including transplantation. Quantitation of bk virus load in serum for the diagnosis of bk virus associated nephropathy in renal transplant recipients. An optn analysis of national registry data on treatment of bk virus allograft nephropathy in the united states. Untreated bkv infections lead to kidney allograft dysfunction or loss. Jun 12, 2003 bk virus bkv, a human polyomavirus, infects most of the human population, but clinically relevant infections are usually limited to individuals who are immunosuppressed. This is a worrisome problem since established bk virus nephropathy is associated with allograft failure in 15 to 50 percent of cases. Bk virus nephropathy university of tennessee health. Bk virus nephropathy polyomavirus adding insult to injury. Jan 21, 2016 the overall goal of this study is to rapidly improve clearance of bk viremia with immunoglobulin privigen thereby decreasing the potential for formation of alloantibodies in renal transplant recipients that have had immunosuppression reduction due to bk viremia. Are there concomitant acute cellular rejection, banff type ib.
Bkvirus nephropathy in renal transplantstubular necrosis. Bk virus nephropathy bkvn is one of the complications of renal transplantation that causes graft loss in renal transplant recipients. The prevalence of bk viruria, viremia, and nephritis after renal tx has been estimated at 30, and 8%, respectively. Bk virusassociated nephropathy in a patient with aids.
Bk virus bkv and jc virus are the two most common polyoma viruses associated with human disease and the only two associated with nephropathy bkvn. Bk virusassociated nephropathy occurring in association with human immunodeficiency virus infection and acquired immunodeficiency syndrome aids was reported only rarely. The reactivation of bk virus in renal transplant recipients is largely asymptomatic, and routine surveillance especially in the first 1224 months after transplant is necessary for early recognition and intervention. A value of less than 500 bkv dna copiesml indicates that the patients viral load is below the quantitative limit of this assay, and does not indicate that the patient is not infected with bkv. A value of less than 500 bkv dna copiesml indicates that the patients viral load is below the quantitative limit of this assay, and does not indicate that the patient is. Learn more about diabetic nephropathy from related diseases, pathways, genes and ptms with the novus bioinformatics tool. The costeffectiveness of routine monitoring was evaluated in a canadian study. Bk viral nephropathy bkvn can lead to deterioration. There is no objective data concerning bk virus nephropathy treatment, as current therapeutic recommendations are largely based on small case series 5,23,25,35. Bk polyomavirus in solid organ transplantation wiley online library. Screening for bk virus nephropathy in kidney transplant recipients. Bk virus nephropathy and kidney transplantation daniel l. Jun 22, 2001 control patients were 16 transplant recipients who did not develop bk virus associated nephropathy.
Progressive multifocal leukoencephalopathy pml is a fatal demyelinating disease of the central nervous system cns seen. Nephritis and nephropathy not specified as acute or chronic in diseases classified elsewhere short description. Sukov, md, 1matthew lewin, md, sanjeev sethi, md, phd, thomas a. Since the first report of bkvan in 1995, numerous studies have been conducted on bkv 6. Bk virus nephropathy and vascular endothelium request pdf. Polyomavirus pv, a subgroup of the papovavirus family, is a double stranded nonenveloped dna virus. Mar, 2012 tropism of the virus for renal tubular cells and their replication in these cells. Bk virus nephropathy in a renal transplant patient. Editorial from the new england journal of medicine bk virus nephropathy polyomavirus adding insult to injury.
Nephropathy from bk virus bkv infection is an evolving challenge in kidney transplant recipients. This is followed by bk viremia and bk virus nephropathy bkvn seen respectively in 530% and 110% of kidney transplant patients. Bk virus load decreased in all 3 patients who had nephrectomy, lessened immunosuppression, or both. Bk virus nephropathy bkvn occurs in up to 10% of renal transplant recipients and can result in graft loss. Bk virus nephropathy has been diagnosed in patients receiving a maintenance therapy consisting of different drug classes, such as calcineurin inhibitors, antimetabolites, mammalian target of rapamycin inhibitors, and corticosteroids. The aim of this study was to determine the prevalence, load, and genotypes of bk and jc viruses circulated in potential kidney donors in kuwait. In this investigation, it was determined that routine bkv screening becomes costeffective only if the incidence of bkvn in a transplant program exceeds 2.
Bk virusassociated nephropathy in kidney transplant recipients. The rate of graft loss was greater than 50% in the 1990s, but has fallen to as low as 15% due to regular screening, and preemptive reduction of immunosuppression. The nephropathy is a consequence of bkpyv reactivation in the urinary tract of the donor kidneyureter with subsequent viremia and invasion of the virus in the graft causing viral cytopathic changes, inflammatory response and functional deterioration. Nephropathy secondary to bk virus in the native kidney is uncommon. Bk virus bkv is a polyomavirus that is able to cause renal. Manifest polyomavirus infection of renal allografts with the bkvirus strain, i. The virus become active and causes infection when there is an immunocompromised state in the body. Past infection with the bk virus is widespread, but significant consequences of infection are uncommon, with the exception of the immunocompromised and the immunosuppressed.
The bk virus was first isolated from the urine of a renal transplant recipient with ureteric stenosis in 1971, but it was not until 20 years later that bk was recognized as a cause of interstitial nephritis and allograft failure in renal transplant recipients 2, 3. Listing a study does not mean it has been evaluated by the u. New practice versus traditional approach the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A diagnosis of bk virus nephropathy is established by a combination of characteristic histological, immunostaining, and ultrastructural. Polyomavirus continues to represent a formidable challenge in kidney transplantation. Bk virus associated nephropathy is an important cause of allograft failure and affects renal transplant patients an average of 44 weeks posttransplant. Jul 11, 2014 bk virus nephropathybk virus nephropathy slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Incidence of bk virus nephropathy bkvn in renal transplant. Based on dna sequence variations, bk can be divided into six subtypes or genotypes. Case reports bk virus nephropathy due to kom3 strain gavin s. Louis, missouri nephropathy from bk virus bkv infection is an evolving challenge in kidney transplant recipients. The bk genome encodes three capsid structural proteins, such as viral capsid protein 1 vp1, vp2 and vp3, as well as the large t and small t antigens. Bk virus nephropathy presents with renal dysfunction, which may be confused with acute rejection.
Bk virus is a virus that most people get in childhood. Although 10%30% of kidney recipients have bk viremia, nephropathy occurs in approximately 2% 11. Bk virusassociated nephropathy in a patient with aids mayo. The use of immunosuppressive medications in these individuals allows this virus to replicate within the graft resulting in bk polyomavirus nephropathy. Bkpyv replication in urine precedes bkpyv viremia by a median of 4. Although bk virus is thought of as a nephrotropic virus as opposed to the cnstropic jc virus, rare cases of bk pul. Graft loss will occur if the process is not managed appropriately.
Nephropathy secondary to bk virus, a member of the papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. Bk virus nephropathy is a serious complication of kidney transplantation. Analysis of diagnostic methods as a screening test to. Asymptomatic bk virus infection is often acquired in childhood and the virus persists in urothelium and kidneys of healthy individuals, where it can be reactivated under immunosuppression. Bk virus nephropathy and kidney transplantation american. Bk virusassociated nephropathy is a relevant topic in the new era of. Bk virus, polymomaviruses, viral nephropathy, ki viruses, wu viruses, jc virus. However, each showed diverse prevalences and outcomes of bkvan 6,7. The aim of this study was to search for bkv replication within the bone marrow of kidneytransplant patients presenting with a. Bk virus infects people with kidney and bone marrow.
The latter 2 viruses have been the focus of most published work on viral pathobiology. The diagnosis of bkv nephropathy requires allograft biopsy, however, it may be too late to. Bk polyoma virus infection and renal disease in nonrenal solid. The human polyomavirus bk bkv is associated with severe complications, such as ureteric stenosis and polyomavirusassociated nephropathy pvan, which often occur in kidneytransplant patients. Increasing degrees of immunsuppression are associated with increased risk for bk reactivation. Bk virus nephropathy and other polyoma virus infections. We describe the case of a 43yearold man with aids presenting with nonoliguric renal failure. There is no consensus definition for allograft dysfunction following kidney transplant. Bk virusassociated nephropathy in kidney transplant.
Age 50yrs, male gender and diabetes have also been found to have increased risk. Molecular characterization of bk and jc viruses circulating. Bkvirus nephropathy genetic and rare diseases information. To describe a rare case of bk virus associated progressive multifocal leukoencephalopathy. Once you get a bk virus infection, the virus stays in your system for good. Bk polyoma virus by realtime pcr detection and quantitation background information acquired in childhood or adolescence, the polyoma virus bkv is one of a few polyoma virus infections that infect humans. Clinical characteristics and outcomes of lateonset bk virus nephropathy in kidney and kidneypancreas transplant recipients. Bk and jc polyomaviruses can be associated with nephropathy following renal transplantation. Bkvirusnephropathie nach nierentransplantation springerlink. Nephropathy is most common early after transplant when immunosuppression is at its peak. Tropism of the virus for renal tubular cells and their replication in these cells. Sometimes, when your immune system is not working well, the virus wakes up.
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