Polyomavirus nephropathy: a current perspective and clinical considerations.

@article{Wiseman2009PolyomavirusNA,
  title={Polyomavirus nephropathy: a current perspective and clinical considerations.},
  author={Alexander Wiseman},
  journal={American journal of kidney diseases : the official journal of the National Kidney Foundation},
  year={2009},
  volume={54 1},
  pages={
          131-42
        }
}
  • A. Wiseman
  • Published 1 July 2009
  • Medicine, Biology
  • American journal of kidney diseases : the official journal of the National Kidney Foundation
During the last decade, the human polyomaviruses (BK virus and, much less commonly, JC virus) have entered the realm of routine clinical decision making for providers caring for kidney transplant recipients. The emergence of polyomavirus-associated nephropathy (PVAN) as an important clinical entity coincided with the development and use of more potent immunosuppression agents, currently the only clear risk factor for reactivation of the virus. Ongoing efforts to define the pathogenesis… 
View on PubMed
ucdenver.edu
96 Citations
Highly Influential Citations
15
Background Citations
51
Methods Citations
6
Results Citations
1

Figures and Tables from this paper

96 Citations

BK Polyomavirus: Clinical Aspects, Immune Regulation, and Emerging Therapies
TLDR
Development of immune-based therapies to combat BKV may provide new and exciting opportunities for the successful treatment of BKVs-associated complications, as well as improved diagnostic tools and clinical management strategies.
JC viraemia in kidney transplant recipients: to act or not to act?
TLDR
Polymerase chain reaction (PCR) screening for BK polyomavirus in the early post-transplant period is routinely performed worldwide but is not known to occur for JC polyomvirus.
BK Polyomavirus in Renal Transplantation
TLDR
This narrative review will discuss the epidemiology, risk factors, clinical features, screening, diagnosis and management of BKV infection in the setting of kidney transplantation, as well as suggest future research directions.
Fluoroquinolones and BK Virus Nephropathy: A Myth or a Reality
TLDR
This review will focus the evidence available for using fluoroquinolones in prevention of BKVN and its usefulness, and a way forward to use these agents or not for Prevention of BkVN will also be discussed.
BK Virus Nephropathy in Kidney Transplantation: A State-of-the-Art Review
TLDR
In this in-depth state-of-the-art review, the history of the virus, virology, epidemiology, cellular response, pathogenesis, methods of screening and diagnosis, evidence-based treatment strategies, and upcoming therapeutics are discussed, along with the issue of re-transplantation in patients.
Infezione da polyomavirus BK e patologia correlata dopo trapianto renale
TLDR
Protocols of adoptive T-cell transfer based on infusion of BKv-specific T cells are the object of many studies and should be considered an innovative treatment approach for pyvaN.
BK virus infection: an update on diagnosis and treatment.
  • D. Sawinski, S. Goral
  • Medicine, Biology
    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
  • 2015
TLDR
The epidemiology of BK virus infection, screening strategies, treatment options and future research directions are discussed and laboratory-based methods such as ELISPOT assays have provided new insights into the immune response to BK and may help guide therapy in the future.
BK virus infection: an update on diagnosis and treatment
TLDR
The epidemiology of BK virus infection, screening strategies, treatment options and future research directions are discussed and laboratory-based methods such as ELISPOT assays have provided new insights into the immune response to BK and may help guide therapy in the future.
Impact of HMG‐CoA reductase inhibitors on the incidence of polyomavirus‐associated nephropathy in renal transplant recipients with human BK polyomavirus viremia
TLDR
It is postulated that statin therapy may prevent the progression of BKPyV viremia to PyVAN, a pre‐requisite of polyomavirus‐associated nephropathy (PyVAN) and the only effective therapy against pyVAN.
Polyoma BK Virus in Kidney Transplant Recipients: Screening, Monitoring, and Management
TLDR
Active screening to detect BKPyV viremia is recommended, particularly during the early posttransplant period, and treatment strategies should be individualized to the recipient’s underlying immunological risk and severity of the allograft infection.
...
...

References

SHOWING 1-10 OF 113 REFERENCES
Histologic versus molecular diagnosis of BK polyomavirus-associated nephropathy: a shifting paradigm?
TLDR
Analysis of current clinical trends indicates that despite the fact that a positive renal biopsy is the "gold standard" for the diagnosis of BKPVAN, clinical interventions often are based on the surrogate markers of the disease rather than on tissue diagnosis, and strong arguments remain, however, in favor of retaining the requirement for tissue evaluation in patients who are suspected of having BKVAN.
Polyomavirus BK.
Polyomavirus BK Nephropathy: A (Re‐)emerging Complication in Renal Transplantation
  • H. Hirsch
  • Medicine, Biology
    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
  • 2002
TLDR
Persisting polyomavirus replication is now widely recognized as a (re‐)emerging cause of renal allograft dysfunction and management aims at the judicious modification and/or reduction of immunosuppression which, in view of preceding or concurrent rejection, is not without risk.
Polyomavirus‐associated nephropathy: update in diagnosis
TLDR
Viremia has emerged as the most specific test for the diagnosis of BK PVAN, and currently there are no tools to differentiate acute cellular rejection from viral specific T‐cell response.
Retransplantation After Polyomavirus‐Associated Nephropathy: Just do it?
  • H. Hirsch, E. Ramos
  • Medicine, Biology
    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
  • 2006
TLDR
Testing for BKV replication has become the pivotal diagnostic assay for clinical decision making and many cases are still diagnosed in a stage of diffuse interstitial nephritis termed PVAN B which presents with allograft dysfunction.
Immunosuppression reduction for BK virus nephropathy: a case for caution
TLDR
A case of antibody‐mediated rejection that followed reduction of immunosuppression for BKVN diagnosed more than 3 months after the onset of viremia is reported, which resulted in a greater decrease in graft function than the initial BKvN episode.
Polyomavirus Infection and Acute Vascular Rejection in a Kidney Allograft: Coincidence or Mimicry?
  • I. McGilvray, G. Lajoie, A. Humar, M. Cattral
  • Medicine
    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
  • 2003
TLDR
A kidney‐pancreas transplant recipient with PV infection is reported, in whom both vascular and cellular rejection were dominant histologic features in a renal biopsy specimen, and the need for caution when such changes are attributed to rejection is highlighted.
Incidence of polyomavirus-nephropathy in renal allografts: influence of modern immunosuppressive drugs.
  • M. Mengel, M. Marwedel, H. Kreipe
  • Medicine, Biology
    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
  • 2003
TLDR
A small group of patients under intensive immunosuppression comprising tacrolimus in combination with mycophenolate mofetil has a significantly increased risk of acquiring this deleterious complication.
BK virus nephropathy in a heart transplant recipient: case report and review of the literature
TLDR
Although this is only the fourth case reported, BKV nephropathy should be considered in the differential diagnosis of new renal failure following non‐kidney solid organ transplantation, as early diagnosis of PVAN is necessary to prevent irreversible renal damage.
Screening to Prevent Polyoma Virus Nephropathy: A Medical Decision Analysis
  • B. Kiberd
  • Medicine
    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
  • 2005
TLDR
Screening for polyomavirus nephropathy may well be cost‐effective if not cost saving in centers with high PVN rates and much of the cost savings relate to savings from immunosuppression reduction in the screened arm.
...
...