BK Polyomavirus Nephropathy leads to rejection in Kidney Transplant Recipients
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 2
Abstract
Over the past decade, infection of kidney transplants with BK polyomavirus has become increasingly appreciated. The infection is manifested by both an inflammatory response and subsequent fibrotic response, leading to renal dysfunction and eventual irreversible graft loss. The pathogenesis of this disease is due to over-immunosuppression with concomitant tubular injury. It remains unclear whether the tubular damage is either due to viral effect or virally-directed immune response. Renal biopsy is the gold standard of diagnosis of BKV nephropathy. Post-transplant BKV quantification has been performed by Real Time PCR. Pre transplant HLA typing has been done by SSOP method using Luminex. Pre transplant Patient Donor crossmatch has been performed by serological method with DTT and AHG augmentation. Post-Transplant protocol biopsies are done for all the patients. Statistical analysis has been done with Origin Pro 9.0. In our study we have seen 64 biopsies from kidney transplant recipients. 15 patients among 64 have been diagnosed with active BKV infection by quantitative PCR and 2 of them experienced graft loss. The histological hallmarks of this disease are viral cytopathic changes in renal tubular epithelial cells, which occur in medullary and distal tubules in early disease, and proximal tubules in more advanced stages. Other site includes vascular and parietal glomerular epithelium along with interstitial inflammatory cell infiltration.Some clinicians contend that this infiltrative process is an appropriate viral-specific immune response, and for that reduction in immunosuppression is warranted.
Authors and Affiliations
Sanjukta Goswami, Arpita Ghosh Mitra, Sudip Roy, Dilip Kumar Pahari
Keywords
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