Diagnosis and treatment of BK virus-associated nephropathy after renal transplantation / 中华器官移植杂志

ABSTRACT

Objective To explore the diagnosis and treatment of BKV nephropathy after renal transplantation .Methods A total of 62 patients with progressive creatinine elevation were routinely examined by blood and urine BKV-DNA . And 21 patients with positive results underwent graft biopsies for confirming a diagnosis .Results Among 21 cases of BKV infection ,20 cases received leflunomide in replacing mycophenolate mofetil (MMF) and a lower dose of tacrolimus .One case with urine (-) & blood (+ ) received sirolimus in replacing tacrolimus and a lower dose of MMF .Among 11 cases with urine (+ ) and blood (-) ,urinary BKV-DNA turned negative & creatinine decreased markedly (n= 4) ,urinary BKV-DNA load decreased & creatinine stablized (n= 4) ,death from pulmonary infection with hepatic & renal failure (n=1) ,urine BKV-DNA load decreased & creatine increased ( n = 1 ) , BKV – DNA load was not re-examined in 1 case of acute rejection and hydronephrosis with elevated creatine ;Among 9 cases with urine (+ ) & blood (+ ) ,blood BKV-DNA turned negative with urinary BKV-DNA load & creatine decreased (n= 6) ,blood BKV-DNA load decreased & creatine stablized (n=2) and no re-examination with a stable level of creatine (n=1);One case with urine (-) & blood (+ ) was not timely treated and ultimately leading to graft loss after an onset of acute rejection .Conclusions BKV nephropathy may be effectively treated by decreasing immunosuppressive intensity . However ,clinicians should stay on a high alert for acute rejection due to an excessive reduction of immunosuppressive agents .