Production and concentration of keratinases and application of fermentation residual in removing hexavalent chromium.

The production of keratinases was evaluated in submerged fermentation with Aspergillus niger and by pigs' swine hair in a batch bioreactor. Experimental planning was performed to assess the interaction between different variables. The enzyme extract produced was characterized at various pH and temperatures and subjected to enzyme concentration using a biphasic aqueous system and salt/solvent precipitation techniques. In addition, the substrate's potential in reducing hexavalent chromium from synthetic potassium dichromate effluent with an initial concentration of 20 mg L-1 of chromium was evaluated. The resulting enzyme extract showed 89 ± 2 U mL-1 of keratinase. The enzyme concentration resulted in a purification factor of 1.3, while sodium chloride/acetone and ammonium sulfate/acetone resulted in a purification factor of 1.9 and 1.4, respectively. Still using the residual substrate of swine hair from the fermentation, a 94% reduction of hexavalent chromium concentration occurred after 9 h of reaction. Thus, the study proved relevant for producing keratinases, with further environmental applicability and the possibility of concentrating the extract via low-cost processes.

Response surface methodology-based optimisation of adsorption of diclofenac and treatment of pharmaceutical effluent using combined coagulation-adsorption onto nFe2O3 decorated water chestnut shells biochar.

This work involved the preparation of pristine and iron nanoparticle-loaded biochar from a water chestnut shell to remove diclofenac sodium (DCF) containing effluent of pharmaceutical origin. To create suitable forecasting equations for the modelling of the DCF adsorption onto the adsorbent, response surface methodology (RSM) was used. The parameters, e.g. pH, adsorbent mass, DCF concentration and contact time, were used for the modeling of adsorption. The RSM model predicts that for 98.0% DCF removal, the ideal conditions are pH 6, an adsorbent dose of 0.5 g L-1, and a contact time of 60 min with an initial adsorbate concentration of 25 mg L-1 at 303 K. The maximum capacity deduced from the Langmuir model was 75.9 mg g-1 for pristine water chestnut shell biochar (pWCBC) and 122.3 mg g-1 for magnetically modified nano-Fe2O3 biochar (mWCBC). Under equilibrium conditions, the Langmuir model was the best-suited model compared to the Temkin and Freundlich models. The adsorption data in this investigation efficiently fitted the pseudo-second-order model, emphasizing that chemisorption or ion exchange processes may be involved in the process. The WCBC demonstrated recyclability after 10 cycles of repeated adsorption and desorption of DCF. A combined coagulation adsorption process removed COD, NH3-N, NO3-, PO43-, and DCF by 92.50%, 86.41%, 77.57%, 84.54%, and 97.25%, respectively. This study therefore shows that coagulation followed by adsorption onto biochar can be a cost-effective substitute for conventional pharmaceutical wastewater treatment.

Burden of rare genetic disorders in India: twenty-two years' experience of a tertiary centre.

BACKGROUND: Rare disorders comprise of ~ 7500 different conditions affecting multiple systems. Diagnosis of rare diseases is complex due to dearth of specialized medical professionals, testing labs and limited therapeutic options. There is scarcity of data on the prevalence of rare diseases in different populations. India being home to a large population comprising of 4600 population groups, of which several thousand are endogamous, is likely to have a high burden of rare diseases. The present study provides a retrospective overview of a cohort of patients with rare genetic diseases identified at a tertiary genetic test centre in India. RESULTS: Overall, 3294 patients with 305 rare diseases were identified in the present study cohort. These were categorized into 14 disease groups based on the major organ/ organ system affected. Highest number of rare diseases (D = 149/305, 48.9%) were identified in the neuromuscular and neurodevelopmental (NMND) group followed by inborn errors of metabolism (IEM) (D = 47/305; 15.4%). Majority patients in the present cohort (N = 1992, 61%) were diagnosed under IEM group, of which Gaucher disease constituted maximum cases (N = 224, 11.2%). Under the NMND group, Duchenne muscular dystrophy (N = 291/885, 32.9%), trinucleotide repeat expansion disorders (N = 242/885; 27.3%) and spinal muscular atrophy (N = 141/885, 15.9%) were the most common. Majority cases of ß-thalassemia (N = 120/149, 80.5%) and cystic fibrosis (N = 74/75, 98.7%) under the haematological and pulmonary groups were observed, respectively. Founder variants were identified for Tay-Sachs disease and mucopolysaccharidosis IVA diseases. Recurrent variants for Gaucher disease (GBA:c.1448T > C), ß-thalassemia (HBB:c.92.+5G > C), non-syndromic hearing loss (GJB2:c.71G > A), albinism (TYR:c.832 C > T), congenital adrenal hyperplasia (CYP21A2:c.29-13 C > G) and progressive pseudo rheumatoid dysplasia (CCN6:c.298T > A) were observed in the present study. CONCLUSION: The present retrospective study of rare disease patients diagnosed at a tertiary genetic test centre provides first insight into the distribution of rare genetic diseases across the country. This information will likely aid in drafting future health policies, including newborn screening programs, development of target specific panel for affordable diagnosis of rare diseases and eventually build a platform for devising novel treatment strategies for rare diseases.

Spinal dysraphism in congenital scoliosis and kyphosis: a retrospective analysis in an Indian population.

PURPOSE: Early recognition is crucial for occult spinal dysraphism associated with congenital spinal deformities. There is limited literature available on its occurrence in congenital scoliosis and kyphosis in the Indian population. METHODS: Our study involved a retrospective review of 247 children who presented at a single centre. We analyzed their demographics and clinical and radiological findings, which included the type of deformity, its location, vertebral anomaly, Cobb angle, and MRI findings. The deformities were categorized as congenital scoliosis or congenital kyphosis with failure of formation, failure of segmentation, or both. RESULTS: A total of 247 cases were examined (congenital scoliosis-229, congenital kyphosis-18). The average age was seven years (range 0.8 to 19 years, SD 4.6). The mean Cobb angle at presentation in the congenital scoliosis group was 49.4° (range 8 to 145°, SD 23.77) for those with abnormal MRI and 42.45° (range 5 to 97°, SD 20.09) for those with normal MRI. For the congenital kyphosis group, the mean K angle at presentation was 47.7° (range 14 to 110°, SD 33.33) for those with abnormal MRI and 47.36° (range 15 to 70°, SD 16.63) for those with normal MRI. Abnormal MRI results were observed in 130 of the patients (congenital scoliosis-53.7%, congenital kyphosis-38.8%). The highest incidence of abnormal MRI findings was observed in the failure of segmentation (66.6%) and mixed (65%) types. Deformities in the dorsal region had the highest incidence (61.9%). The most common dysraphism instances were diastematomyelia and tethered cord. There was a significant correlation between type of deformity and presence of dysraphism. CONCLUSION: This is the largest case series of congenital scoliosis and kyphosis reported from India. We found a high incidence of occult spinal dysraphism as compared to other published series. Occult spinal dysraphism is more common in the thoracic region. Diastematomyelia followed by tethered cord was the most common anomaly observed. We recommend MRI screening of whole spine and craniovertebral junction.

Are Generative Pretrained Transformer 4 Responses to Developmental Dysplasia of the Hip Clinical Scenarios Universal? An International Review.

OBJECTIVE: There is increasing interest in applying artificial intelligence chatbots like generative pretrained transformer 4 (GPT-4) in the medical field. This study aimed to explore the universality of GPT-4 responses to simulated clinical scenarios of developmental dysplasia of the hip (DDH) across diverse global settings. METHODS: Seventeen international experts with more than 15 years of experience in pediatric orthopaedics were selected for the evaluation panel. Eight simulated DDH clinical scenarios were created, covering 4 key areas: (1) initial evaluation and diagnosis, (2) initial examination and treatment, (3) nursing care and follow-up, and (4) prognosis and rehabilitation planning. Each scenario was completed independently in a new GPT-4 session. Interrater reliability was assessed using Fleiss kappa, and the quality, relevance, and applicability of GPT-4 responses were analyzed using median scores and interquartile ranges. Following scoring, experts met in ZOOM sessions to generate Regional Consensus Assessment Scores, which were intended to represent a consistent regional assessment of the use of the GPT-4 in pediatric orthopaedic care. RESULTS: GPT-4's responses to the 8 clinical DDH scenarios received performance scores ranging from 44.3% to 98.9% of the 88-point maximum. The Fleiss kappa statistic of 0.113 ( P = 0.001) indicated low agreement among experts in their ratings. When assessing the responses' quality, relevance, and applicability, the median scores were 3, with interquartile ranges of 3 to 4, 3 to 4, and 2 to 3, respectively. Significant differences were noted in the prognosis and rehabilitation domain scores ( P < 0.05 for all). Regional consensus scores were 75 for Africa, 74 for Asia, 73 for India, 80 for Europe, and 65 for North America, with the Kruskal-Wallis test highlighting significant disparities between these regions ( P = 0.034). CONCLUSIONS: This study demonstrates the promise of GPT-4 in pediatric orthopaedic care, particularly in supporting preliminary DDH assessments and guiding treatment strategies for specialist care. However, effective integration of GPT-4 into clinical practice will require adaptation to specific regional health care contexts, highlighting the importance of a nuanced approach to health technology adaptation. LEVEL OF EVIDENCE: Level IV.

Multiple Metacarpal Loss Secondary to Tuberculous Dactylitis: Challenges and Management: A Case Report.

Tuberculous dactylitis is infrequently seen after the age of 6 years. The index and middle fingers are the most common sites. Early diagnosis is essential to eradicate the infection. Delay in diagnosis and management leads to extensive involvement which may require surgical intervention. The current literature reveals conservative management gives satisfactory results in early stages. Though surgical intervention in Tuberculous dactylitis is seldom required, delay in diagnosis and management leads to extensive involvement of the bone and sequestration which does not respond to Anti Tubercular Therapy and needs staged surgical interventions. We report a case of an 11-year-old girl who presented to us after extensive involvement of 2nd and 3rd metacarpals and failed to respond to ATT even after 1.5 years of medication. She required staged surgeries to eradicate the infection which led to loss of 2nd and 3rd metacarpals. Complex reconstructive procedures of hand were required in stages and the bone loss was managed with non-vascularized Fibular strut graft. At 2 years of follow up, there is complete incorporation of the graft, and the patient has satisfactory functions of the hand and can carry out activities of daily living with ease.

Effects of pericardiocentesis on renal function and cardiac hemodynamics.

BACKGROUND: Previous case studies have reported reversal of acute renal failure after pericardiocentesis in pericardial effusion. This study examines the effects of pericardiocentesis on preprocedural low cardiac output and acute renal dysfunction in patients with pericardial effusion. METHODS: This is a retrospective study of 95 patients undergoing pericardiocentesis between 2015 and 2020. Pre- and post-procedure transthoracic echocardiograms (TTE) were reviewed for evidence of cardiac tamponade, resolution of pericardial effusion, and for estimation of right atrial (RA) pressure and cardiac output. Laboratory values were compared at presentation and post-procedure. Patients on active renal replacement therapy were excluded. RESULTS: Ninety-five patients were included for analysis (mean age 62.2 ± 17.8 years, 58% male). There was a significant increase in glomerular filtration rate pre- and post-procedure. Fifty-six patients (58.9%) had an improvement in glomerular filtration rate after pericardiocentesis (termed "responders"), and these patients had a lower pre-procedure glomerular filtration rate than "non-responders." There was a significant improvement in estimated cardiac output and right atrial pressure for patients in both groups. Patients who had an improvement in renal function had significantly lower pre-procedural diastolic blood pressure and mean arterial pressure. CONCLUSIONS: Pericardial drainage may improve effusion-mediated acute renal dysfunction by reducing right atrial pressure and thus systemic venous congestion, and by increasing forward stroke volume and perfusion pressure.

Nanomaterials for intelligent CRISPR-Cas tools: improving environment sustainability.

Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein (Cas) is a desirable gene modification tool covering a wide area in various sectors of medicine, agriculture, and microbial biotechnology. The role of this incredible genetic engineering technology has been extensively investigated; however, it remains formidable with cargo choices, nonspecific delivery, and insertional mutagenesis. Various nanomaterials including lipid, polymeric, and inorganic are being used to deliver the CRISPR-Cas system. Progress in nanomaterials could potentially address these challenges by accelerating precision targeting, cost-effectiveness, and one-step delivery. In this review, we highlighted the advances in nanotechnology and nanomaterials as smart delivery systems for CRISPR-Cas so as to ameliorate applications for environmental remediation including biomedical research and healthcare, strategies for mitigating antimicrobial resistance, and to be used as nanofertilizers for enhancing crop growth, and reducing the environmental impact of traditional fertilizers. The timely co-evolution of nanotechnology and CRISPR technologies has contributed to smart novel nanostructure hybrids for improving the onerous tasks of environmental remediation and biological sustainability.

Autochthonous psychrophilic hydrocarbonoclastic bacteria and its ecological function in contaminated cold environments.

Petroleum hydrocarbon (PH) pollution has mostly been caused by oil exploration, extraction, and transportation activities in colder regions, particularly in the Arctic and Antarctic regions, where it serves as a primary source of energy. Due to the resilience feature of nature, such polluted environments become the realized ecological niches for a wide community of psychrophilic hydrocarbonoclastic bacteria (PHcB). In contrast, to other psychrophilic species, PHcB is extremely cold-adapted and has unique characteristics that allow them to thrive in greater parts of the cold environment burdened with PHs. The stated group of bacteria in its ecological niche aids in the breakdown of litter, turnover of nutrients, cycling of carbon and nutrients, and bioremediation. Although such bacteria are the pioneers of harsh colder environments, their growth and distribution remain under the influence of various biotic and abiotic factors of the environment. The review discusses the prevalence of PHcB community in colder habitats, the metabolic processes involved in the biodegradation of PH, and the influence of biotic and abiotic stress factors. The existing understanding of the PH metabolism by PHcB offers confirmation of excellent enzymatic proficiency with high cold stability. The discovery of more flexible PH degrading strategies used by PHcB in colder environments could have a significant beneficial outcome on existing bioremediation technologies. Still, PHcB is least explored for other industrial and biotechnological applications as compared to non-PHcB psychrophiles. The present review highlights the pros and cons of the existing bioremediation technologies as well as the potential of different bioaugmentation processes for the effective removal of PH from the contaminated cold environment. Such research will not only serve to investigate the effects of pollution on the basic functional relationships that form the cold ecosystem but also to assess the efficacy of various remediation solutions for diverse settings and climatic conditions.

Patellar Tendon Rupture During Postoperative Physiotherapy for Crouch Gait: A Case Report.

INTRODUCTION: A 14-year-old adolescent girl with spastic diplegic cerebral palsy underwent bilateral distal femur extension osteotomy and patellar tendon plication. Two and a half months after surgery, during physiotherapy, she sustained mid-substance tear of the left patellar tendon. The girl was successfully managed with patellar tendon repair and augmentation with tensor fascia lata autograft. CONCLUSION: Patellar tendon rupture during rehabilitative physiotherapy after patellar tendon plication surgery is rare. Postoperative protocols in patients with cerebral palsy are crucial and should progress gradually to improve knee range of motion. This report highlights that patellar tendon repair with fascia lata augmentation yields good outcome.

Challenges in Management of Proximal Humerus Diaphyseal Fracture in a Patient with Brachial Plexus Birth Injury: A Case Report.

CASE: Two-and-a-half-month-old boy, a known case of brachial plexus birth injury, sustained proximal humeral diaphyseal fracture. Fracture healed in varus malunion and failed to remodel subsequently. Challenges were faced in the course of the management because of progression of the deformity. Finally, the fracture united after rigid internal fixation performed at 2.5 years. CONCLUSION: Neuromuscular imbalance can lead to angular deformity at fracture site and cause unpredictable remodeling, as in our case. Conservative management may fail to achieve union with satisfactory alignment. Rigid internal fixation should be considered in such cases to achieve union.

Maternal Group B Streptococcus Prophylaxis Improvement using an Electronic Medical Record Dynamic Order Set.

OBJECTIVE: To develop and implement a Group B Streptococcal (GBS) dynamic order set to improve adherence to the American College of Obstetricians and Gynecologists/Centers for Disease Control and Prevention (ACOG/CDC) guidelines. STUDY DESIGN: A team of information technology and clinical experts developed a dynamic order block. The content was patterned after the CDC "Prevent GBS" mobile app. It was then embedded in the labor and delivery/induction order set and piloted at a single high-volume obstetric unit. Following the pilot and incorporation of the 2019 ACOG update of the CDC guidelines, the order set was rolled out in five additional hospitals within a region of a large health system. Information on GBS prophylaxis performance before and after implementation was available for the pilot site and four of the additional hospitals. Information before implementation was obtained electronically from electronic medical record (EMR) laboratory and pharmacy data and supplemented by manual chart review. Postimplementation data were obtained from discrete order set EMR data elements. Adherence to the guidelines before and after were compared using chi-squared test. RESULTS: There were 7,114 deliveries before implementation and 4,502 after implementation. Preterm delivery occurred in 6.8 and 6.9%, respectively. There was an increase in appropriate treatment of preterm patients (positive and unknown GBS) delivering after implementation (88.7-99.1%, p < 0.001). More patients were reported to have a penicillin allergy before implementation than after implementation (14.7 vs. 11.1%, respectively, p = 0.01). Associated changes in therapy noted after implementation included a nonsignificant decrease in the proportion reporting a high-risk allergy (50.3 vs. 41.9%, p = 0.18), an increase in the appropriate use of clindamycin and vancomycin (64.4 vs. 92.3%, p < 0.001) and a decrease in clindamycin use in those without sensitivity testing. CONCLUSION: Routine universal use of a dynamic admission labor/induction order set was associated with high and improved adherence to GBS prophylaxis guidelines. KEY POINTS: · Lapses in GBS prophylaxis are associated with early-onset GBS disease.. · Preterm delivery and penicillin allergic patients are commonly associated with lapses in prophylaxis.. · Dynamic EMR order set use can improve adherence to clinical guidelines..

Paracetamol mineralization strategy in laboratory scale using Aspergillus niger KCAC.

The emergence of drug resistance, caused due the presence of pharmaceutical contaminant in the environment, highlights the critical need for pharmaceutical drugs management. Pharmaceutical drugs are sourced in wastewater as pharmaceutical industrial effluents, antibiotic misuse, and inappropriate disposal of expired pharmaceuticals, eventually ending up in sewage deposition. In this work, we aimed to degrade paracetamol (APAP) through the mycoremediation approach in laboratory scale. The isolated paracetamol degradation fungal strain, identified as Aspergillus niger KCAC efficiently degraded the drug into non-toxic metabolites. The results demonstrated that 99.6% degradation rate was achieved by Aspergillus niger KCAC. Unique, low-cost, eco-friendly bioformulation of the fungal isolate was prepared during the study using used vegetable cooking oil as substrate. The bioformulation showed extended shelf-life and can be used in future for large-scale application. Thus, this detailed investigation on paracetamol biodegradation may be useful in developing a wastewater treatment system effective against paracetamol-contaminated wastewater.

Advanced oxidation process for the treatment of industrial wastewater: A review on strategies, mechanisms, bottlenecks and prospects.

Due to its complex and, often, highly contaminated nature, treating industrial wastewater poses a significant environmental problem. Many of the persistent pollutants found in industrial effluents cannot be effectively removed by conventional treatment procedures. Advanced Oxidation Processes (AOPs) have emerged as a promising solution, offering versatile and effective means of pollutant removal and mineralization. This comprehensive review explores the application of various AOP strategies in industrial wastewater treatment, focusing on their mechanisms and effectiveness. Ozonation (O3): Ozonation, leveraging ozone (O3), represents a well-established AOP for industrial waste water treatment. Ozone's formidable oxidative potential enables the breakdown of a broad spectrum of organic and inorganic contaminants. This paper provides an in-depth examination of ozone reactions, practical applications, and considerations involved in implementing ozonation. UV/Hydrogen Peroxide (UV/H2O2): The combination of ultraviolet (UV) light and hydrogen peroxide (H2O2) has gained prominence as an AOP due to its ability to generate hydroxyl radicals (ȮH), highly efficient in pollutant degradation. The review explores factors influencing the efficiency of UV/H2O2 processes, including H2O2 dosage and UV radiation intensity. Fenton and Photo-Fenton Processes: Fenton's reagent and Photo-Fenton processes employ iron ions and hydrogen peroxide to generate hydroxyl radicals for pollutant oxidation. The paper delves into the mechanisms, catalyst selection, and the role of photoactivation in enhancing degradation rates within the context of industrial wastewater treatment. Electrochemical Advanced Oxidation Processes (EAOPs): EAOPs encompass a range of techniques, such as electro-Fenton and anodic oxidation, which employ electrode reactions to produce ȮH radicals. This review explores the electrochemical principles, electrode materials, and operational parameters critical for optimizing EAOPs in industrial wastewater treatment. TiO2 Photocatalysis (UV/TiO2): Titanium dioxide (TiO2) photocatalysis, driven by UV light, is examined for its potential in industrial wastewater treatment. The review investigates TiO2 catalyst properties, reaction mechanisms, and the influence of parameters like catalyst loading and UV intensity on pollutant removal. Sonolysis (Ultrasonic Irradiation): High-frequency ultrasound-induced sonolysis represents a unique AOP, generating ȮH radicals during the formation and collapse of cavitation bubbles. This paper delves into the physics of cavitation, sonolytic reactions, and optimization strategies for industrial wastewater treatment. This review offers a critical assessment of the applicability, advantages, and limitations of these AOP strategies in addressing the diverse challenges posed by industrial wastewater. It emphasizes the importance of selecting AOPs tailored to the specific characteristics of industrial effluents and outlines potential directions for future research and practical implementation. The integrated use of these AOPs, when appropriately adapted, holds the potential to achieve sustainable and efficient treatment of industrial wastewater, contributing significantly to environmental preservation and regulatory compliance.

Management of Post-osteomyelitic Large Ulna Defect in a Pediatric Patient.

Osteomyelitic sequelae in forearm pose challenges in management. Bone resorption leading to gap nonunions is further difficult to manage. We present a case of post-osteomyelitic ulna defect of 16 cm in a 6-year-old boy managed by non-vascularized fibular grafting with simultaneous correction of radius deformity and its functional outcome after 1 year.

Brachial Plexus Birth Injury due to Proximal Humeral Physeal Separation: A Case Report.

CASE: A 9-day-old male neonate presented with swelling over his left shoulder and reduced movements of the left upper extremity since birth. Radiographs raised a suspicion of a shoulder dislocation. Ultrasonography confirmed the diagnosis of proximal humeral physeal separation. Magnetic resonance imaging (MRI) revealed edema of the infraclavicular part of the brachial plexus. Conservative management was followed, and the injury remodeled completely at 2 years. CONCLUSION: Neonatal proximal humeral physeal separation poses a diagnostic challenge. Ultrasonography is helpful for diagnosis. MRI is indicated when concurrent brachial plexus birth injury is suspected. Conservative management yields good outcome in the absence of entrapped nerves and tendons.

Treatment of Severe COVID-19 Infection With Remdesivir in Peritoneal Dialysis.

End-stage kidney disease (ESKD) has been shown to be correlated with an increased risk of COVID-19 infection and mortality. Remdesivir is an effective non-EUA U.S. Food and Drug Administration (FDA)-approved antiviral agent for the treatment of COVID-19 in hospitalized adult and pediatric patients, though a lack of data has prevented its use in patients with severe kidney disease including dialysis patients. Some observational studies report the use of remdesivir in hemodialysis patients, but there are no reports of patients treated with remdesivir on peritoneal dialysis. Dialysis modalities may affect drug pharmacokinetics, and safety and efficiency of remdesivir in peritoneal dialysis is unknown. We report the first case, to our knowledge, of using remdesivir in a patient treated with peritoneal dialysis with no significant adverse events. This case illustrates the potential for remdesivir to be considered in peritoneal dialysis patients with severe COVID infection. Proper risk analysis and careful monitoring should be done, given the unpredictable clearance of the drug.

Hip Spica Table: A Technical Note.

Introduction: Hip spica is a widely used treatment modality in the management of various paediatric orthopaedic conditions. A standardized hip spica table is not universally available and various centerres have devised their own designs. In collaboration with the local engineering team, we have designed a light weight yet sturdy, economical and portable hip spica table. Materials and Methods: Components of the spica table and their measurements are described. Technique of mounting and unmounting the patient off the table has been discussed. We have applied the hip spica using the current design in 141 children between 2009 and 2023. The same table has been used for the children aged 6 months to 10 years. We have not experienced any table breakage during spica application. The acrylic sheet was changed only once during the study period due to attrition. Conclusion: Our design has been used successfully at our center for more than 14 years. It is simple, economical, portable and durable. It can be used in dedicated pediatric orthopedic centers and can be carried easily to the field hospitals. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-00935-1.

Native BK Polyomavirus Nephropathy in an Orthotopic Heart Transplant Patient.

BK polyomavirus nephropathy (BKVN) is a common cause of nephropathy in kidney transplant patients and is typically seen within the first year after transplantation. BK polyomavirus nephropathy can occur in the native kidneys of patients with nonrenal solid-organ transplants (NRSOT). However, this is rare, especially outside the early post-transplant period, and BKVN is not usually considered in the differential diagnosis for acute kidney injury in NRSOT patients. We present a case of a 75-year-old man who had undergone orthotopic heart transplant 13 years prior with stable allograft function who developed progressive renal dysfunction in the setting of recent unilateral obstructive nephrolithiasis requiring ureteral stenting. Kidney biopsy demonstrated evidence of polyomavirus nephritis. Serum BK viral load was elevated. Despite reducing immunosuppression and initiating leflunomide, viral clearance was never achieved. The patient experienced progressive failure to thrive before ultimately transitioning to hospice care and dying. The intensity of immunosuppression is a well-known risk factor for viral replication; ureteral stenting has also been associated with BKVN. However, since clinical manifestations of BK viral infections often include a genitourinary (GU) tract pathology, it is important for clinicians to consider BKVN in patients with NRSOT with progressive renal dysfunction, especially in the clinical context of known GU disease.