How is immunosuppression- related BK nephropathy prevented?

Updated: Jan 04, 2016
  • Author: Bethany Pellegrino, MD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

An increasingly recognized problem associated with immunosuppression is BK virus nephropathy. This virus, a member of the human papovavirus family, lives in the human genitourinary tract and replicates in some patients who are immunosuppressed, leading to allograft dysfunction. While antiviral agents such as cidofovir and leflunomide are active against the BK virus, the mainstay of therapy is a reduction in immunosuppression. In one study of 178 pancreas-kidney transplant recipients, the incidence of BK virus nephropathy was found to be low (1.1%), and no evidence of pancreatic allograft dysfunction was evident. Concurrent renal allograft rejection was treated with pulse steroid therapy and a reduction in immunosuppression, and, in one patient, the use of leflunomide, meaningful, though not complete, recovery of renal function was realized. [14] The risk of acute allograft rejection with this reduction in dose is being studied. [15]

The results of one study found that a combination of monthly screening for polyoma BK virus nephropathy (PVN) using PCR and a modest decrease in immunotherapy is a safe and effective in preventing PVN and may significantly decrease cytomegalovirus and Epstein-Barr virus in renal transplant patients. [16]

The results of another study found that monthly nucleic acid testing during the first 6 months post renal allograft and immediate reduction of immunosuppression is effective in preventing BK polyomavirus virus nephropathy (BKVN) in viremic patients. [17]


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