Challenging Issues in Diagnosis and Screening of BK Virus Nephropathy in Kidney Transplant Recipients, A Multicenter Experience in Iranian Population.

INTRODUCTION: BK virus nephropathy (BKVN) is an important complication of kidney transplantation and kidney biopsy remains the gold standard for its diagnosis. Urine/serum polymerase chain reaction (PCR) is a more sensitive diagnostic method, although it has some potential limitations. METHODS: This study enrolled all kidney transplant recipients who underwent kidney transplant biopsy, collected from three medical centers. Urine and serum PCR results of the patients were also collected from the molecular laboratories. The cut-off value for positive viral DNA load in serum and urine were > 104 and > 107 copies/mL, respectively. Sensitivity, specifity, positive and negative predictive values (PPV, NPV) and cut off values for PCR results were compared with pathologic diagnosis among laboratories. RESULTS: Among 369 biopsy samples, 33 (8.9%) had definite diagnosis of BKVN. PCR results were available for 138 cases. Three patients with definite BKVN had negative PCR results. In 22 patients, PCR was positive without evidence of BKVN. The overall sensitivity, specificity, PPV and NPV of PCR for detecting BKVN, based on a unique cut-off value, were 88, 81, 51, and 97%; respectively. The overall accuracy of PCR in all laboratories was high (82 to 86%), however significant inter-laboratory differences in sensitivity and specificity was found . A 2-log difference in threshold value for positive results was observed in one laboratory. CONCLUSION: PCR may show a significant variability between different laboratories. Interpretation of PCR results using a single cut-off value for all laboratories, may decrease the sensitivity for the diagnosis and screening of BKVN.  DOI: 10.52547/ijkd.7143.

High prevalence of SARS-Coronavirus-2 in patients with inflammatory bowel disease and the role of soluble angiotensin converting Enzyme2.

Context: Patients with inflammatory bowel disease (IBD) were found to have the higher intestinal expression of Angiotensin-Converting Enzyme2 (ACE2) that could consequently increase susceptibility to COVID-19 infection.Objective: This study reports the outcomes of COVID-19 infection in a large cohort of IBD patients. We compare levels of serum ACE and IFN-α between COVID19 patients with and without IBD. We performed a cross-sectional retrospective multicenter study.Methods: We enrolled patients with IBD screened for SARS-COV-2 in six medical centres in Iran from June to November 2020. The blood samples were drawn to measure COVID-19 IgM and IgG, and serum levels of sACE2, sACE1, and interferon-α, regardless of suspicious symptoms have done the molecular test.Results: A total of 534 IBD patients were included in the study. Of these, 109 (20.0%) cases had detectable IgG and IgM against SARS-CoV-2. sACE2 levels were higher in IBD patients than controls, whereas ACE1and IFN-α levels were similar among groups.

The Spectrum of Glomerular Diseases in Mashhad According to Kidney Biopsy Records.

INTRODUCTION: Knowing the national statistics of glomerular diseases will help in the management and minimizing their burden in the community. The aim of this study was to assess the overall distribution of subtypes of glomerulonephritis (GN) and the prevalence of renal diseases in a subgroup of diabetic and hypertensive patients. METHODS: This cross-sectional study was conducted on 860 patients with different subtypes of GN diagnosed by percutaneous renal biopsy and histological examination. RESULTS: The most common subtype of GN was membranous GN (30.1%) followed by minimal change disease (20.1%), IgA nephropathy (9.5%) and Lupus nephritis (8.8%), as well as membranoproliferative GN (6.4%), focal segmental GN (5.6%), crescent GN (43, 5%), and DM nephropathy (36, 4.2%). IgA nephropathy and focal segmental GN were mostly common among maleswhile the most female dominant GN was Lupus nephritis. Lupus nephritis was the most common GN diagnosis among subjects who were younger than 29 years old (50%), while the diabetic nephropathy was the most common GN diagnosis among subjects who were older than 53 years old (44.4%). The most common GN among hypertensive subgroups was focal segmental GN (41.7%) followed by diabetic nephropathy (33.3%) whereas the most common subtypes of GN among diabetics was diabetic nephropathy. CONCLUSION: The most common type of GN among Iranian population in Mashhadwas membranous GN and minimal change disease. The distribution of each subtype of glomerular disease depend on the baseline determinants including age, gender and hypertensive state.