How and when do you screen for BK virus Nephropathy at your setting?
An update on BK virus Nephropathy today morning at #iqraakidneyclub
@hafeeq_benil @JyotishGopinat2 @ranji72 @drferoz
An update on BK virus Nephropathy today morning at #iqraakidneyclub
@hafeeq_benil @JyotishGopinat2 @ranji72 @drferoz
BKVAN is a 2-hit disease - with 1) local environmental factors in the kidney (IRI, ureteral injury during transplant) and 2) immunosuppression playing a key role
Risk factors can be donor/recipient/procedure/virus-related:
Risk factors can be donor/recipient/procedure/virus-related:
Local factors are the reason why:
1) BKVAN can occur quite early in transplant
2) BKVAN is more common in renal than other solid organ transplants
1) BKVAN can occur quite early in transplant
2) BKVAN is more common in renal than other solid organ transplants
Which immunosuppressive medication use poses a higher risk for BKVAN?
This meta-analysis could give a clue:
This meta-analysis could give a clue:
Could there be any factors that would DECREASE the risk of BKVAN?
The correlation of viruria and viremia and BKVAN
Viruria indicates only viral shedding into tubular lumen
Viremia indicates interstitial invasion --> more predictive of BKVAN
Viruria indicates only viral shedding into tubular lumen
Viremia indicates interstitial invasion --> more predictive of BKVAN
The Banff working group has classified BKVAN for prognostication using the pvl score and the Banff ci score:
Acute rejection or BKVAN? Always the histological dilemma:
What is the mainstay of therapy?? There is no obvious answer than this!
But what how do we do it? That's where there is no concrete answer!!
But what how do we do it? That's where there is no concrete answer!!
One such approach given below:
Target CnI reduction if there is graft dysfunction
Target antimetabolite reduction if there is no graft dysfunction
Target CnI reduction if there is graft dysfunction
Target antimetabolite reduction if there is no graft dysfunction
Other options than reduction in immunosuppression? No hard evidence...yet:
mTORi instead of CnI
Few promising adjunctive therapies - Leflunomide/Cidofovir/IvIg
RCTs (though negative) done only with quinolones!
mTORi instead of CnI
Few promising adjunctive therapies - Leflunomide/Cidofovir/IvIg
RCTs (though negative) done only with quinolones!
It's almost been 50 years since the virus has been discovered and continues to strike fear among the transplant physicians.
Better to catch it early and therefore the better role of Urine BKV PCR as aptly discussed by @drferoz post session.
Better to catch it early and therefore the better role of Urine BKV PCR as aptly discussed by @drferoz post session.
