UroToday - Polyoma BK virus recently emerged as a significant cause of complication in renal transplantations, which typically may lead to renal dysfunction and overall graft loss secondary to nephritis caused by the BK virus.
Hymes, et al reported on their management and outcome of 20 children who developed BK viremia. They utilized a serum polymerase chase reaction for BKV DNA monthly for the first year in transplant recipients and every six months thereafter, or for unexplained creatinine elevation. With seroconversion to +PCR, patients were managed with reduction of immunosuppression. Renal biopsy was performed if PCR or creatinine did not improve with the reduction of immunosuppression.
The group found that between June 2003 to January 2006, overall 20 children seroconverted for BK virus at a mean of 460 days after renal transplantation. Sixteen underwent renal biopsy. Eight displayed BK nephritis, three displayed acute rejection and five were normal.
Patients with BK nephritis displayed higher PCR and serum creatinine levels and presented later than children with viremia without BK nephritis. There were no differences between the two groups for age, gender, donor source or immunosuppression. Seven children with BK nephritis received treatment with cidofovir. Thirteen patients (65%) had a positive PCR after reduction of immunosuppression or treatment with cidofovir. Renal function was stable in 16 children (80%) at an average of 13 months after seroconversion. Four patients with BK nephritis demonstrated progressive loss of renal function.
The group concluded and stated and that BK virus infection in children can occur as an early complication or may develop years after transplantation. They state that patients with BK nephritis presented later and displayed higher level of viral loads and serum creatinine than viremic patients without BK nephritis. They ended by stating children with BK nephritis remained PCR+ despite reduction of immunosuppression or treatment with cidofovir and were ultimately at a greater risk for loss of renal function.
Leonard C. Hymes, Barry L. Warshaw
Pediatric Transplantation 10(8): 920-922, December 2006.
Reviewed by UroToday Medical Editor Pasquale Casale, MD
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