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Native kidney BK virus nephropathy, a systematic review.

ABSTRACT: BACKGROUND:There is a growing base of literature describing BK nephropathy (BKVN) in patients outside of the setting of kidney transplant. Previous systematic reviews of the literature have been limited by methodology or by the scope of patients included. STUDY DESIGN AND METHODS:Systematic Review (Prospero # CRD42018088524). SETTING & POPULATION:Patients without kidney transplant who had biopsy-proven BKVN. SELECTION CRITERIA FOR STUDIES:Full-text articles that describe native BKVN patient cases. ANALYTICAL APPROACH:Descriptive synthesis. RESULTS:The search identified 630 unique articles of which 51 were included in the final review. Sixty-five cases (including two new cases presented in this review) were identified, all but one occurred in the setting of known immunosuppression. LIMITATIONS:The primary limitation was the exclusion of studies that did not fulfill the stringent review criteria. We excluded reports with only a clinical diagnosis of BKVN, such as those with viruria and/or viremia without biopsy. CONCLUSIONS:As of May 2018, there are 65 reported cases of BKVN in native kidneys. This represents the most comprehensive description of biopsy-proven BKVN in native kidneys to date. Evaluation for BK nephropathy should be considered in immunocompromised patients who exhibit unexplained renal failure.

SUBMITTER: Shah A

PROVIDER: S-EPMC7197190 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Native kidney BK virus nephropathy, a systematic review.

Shah Ankur A Kumar Vinayak V Palmer Matthew B MB Trofe-Clark Jennifer J Laskin Benjamin B Sawinski Deirdre D Hogan Jonathan J JJ

Transplant infectious disease : an official journal of the Transplantation Society 20190511 4

<h4>Background</h4>There is a growing base of literature describing BK nephropathy (BKVN) in patients outside of the setting of kidney transplant. Previous systematic reviews of the literature have been limited by methodology or by the scope of patients included.<h4>Study design and methods</h4>Systematic Review (Prospero # CRD42018088524).<h4>Setting & population</h4>Patients without kidney transplant who had biopsy-proven BKVN.<h4>Selection criteria for studies</h4>Full-text articles that desc ...[more]

PMID: 30907978

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Project description:Background and objectivesThe published tissue adequacy requirement of kidney medulla for BK virus allograft nephropathy diagnosis lacks systematic verification and competes against potential increased procedural risks from deeper sampling.Design, setting, participants, & measurementsWe evaluated whether the presence of kidney medulla improved the diagnostic rate of BK nephropathy in 2244 consecutive biopsy samples from 856 kidney transplants with detailed histologic and virologic results.ResultsMedulla was present in 821 samples (37%) and correlated with maximal core length (r=0.35; P<0.001). BK virus allograft nephropathy occurred in 74 (3% overall) but increased to 5% (42 of 821) with medulla compared with 2% (32 of 1423) for cortical samples (P<0.001). Biopsy medulla was associated with infection after comprehensive multivariable adjustment of confounders, including core length, glomerular number, and number of cores (adjusted odds ratio, 1.81; 95% confidence interval, 1.02 to 3.21; P=0.04). In viremic cases (n=275), medulla was associated with BK virus nephropathy diagnosis (39% versus 19% for cortex; P<0.001) and tissue polyomavirus load (Banff polyomavirus score 0.64±0.96 versus 0.33±1.00; P=0.006). Biopsy medulla was associated with BK virus allograft nephropathy using generalized estimating equation (odds ratio, 2.04; 95% confidence interval, 1.05 to 3.96; n=275) and propensity matched score comparison (odds ratio, 2.24; 95% confidence interval, 1.11 to 4.54; P=0.03 for 156 balanced pairs). Morphometric evaluation of Simian virus 40 large T immunohistochemistry found maximal infected tubules within the inner cortex and medullary regions (P<0.001 versus outer cortex).ConclusionsActive BK virus replication concentrated around the corticomedullary junction can explain the higher detection rates for BK virus allograft nephropathy with deep sampling. The current adequacy requirement specifying targeting medulla can be justified to minimize a missed diagnosis from undersampling.

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Native kidney BK virus nephropathy, a systematic review.

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Native kidney BK virus nephropathy, a systematic review.

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