García Ligero J, Mora Peris B, García García F, Navas Pastor J, Tomás Ros M, Sempere Gutiérrez A, Rico Galiano J L, Fontana Compiano L O
Servicio de Urología, Hospital General Universitario de Murcia.
Actas Urol Esp. 2002 Feb;26(2):104-10. doi: 10.1016/s0210-4806(02)72741-1.
Differential diagnosis of hematuria after bone marrow transplantation (B.M.T.) may include polyomavirus (BK and JC)-associated haemorrhagic cystitis. Many reports have implied BK virus as the major pathogen in the development of hemorrhagic cystitis after BMT. BK viruria is also associated with ureteric stenosis in renal allografts recipients. Viral urinary tract infections are uncommon in healthy individuals, but we can find them frequently in patients under immunosuppressive conditions.
Retrospective study of 123 consecutive B.M.T. recipients in the period from 1995 to 2000, evaluating those with polyomavirus-associated hemorrhagic cystitis. We present patient's characteristics, primary disease, clinical features, diagnosis aspects and treatment of these "hidden hosts of urinary tract".
7 patients (5.7% of B.M.T.) developed BK or JC virus-associated hemorrhagic cystitis; 3 men and 4 women; median patient age was 29 years (range 14 to 45 years). Bacterial, mycobacterial and parasitic urine cultivates had negative results in all of them. The clinical course was characterized by a late onset of haemorrhagic cystitis (days +30 to +132 after BMT). All 7 patients developed macroscopic haematuria (duration 3 to 30 days). In 6 cases Graft Versus Host Disease (G.V.H.D.) criteria were found. Ultrasonographic studies revealed diffuse thickening of bladder wall in 5 patients. Hematuria was managed by hyperhydratation, blood transfusions, transurethral catheter and evacuation of blood clots, continuous bladder irrigation, urine alkalinization and antiviral therapy. No other more aggressive measures were required to stop the bleeding. Only 1 case of transient elevated creatinine.
Polyomavirus-associated haemorrhagic cystitis must be considered in differential diagnosis of hematuria in bone marrow transplantation recipients. Urological management, according with the severity and duration of hematuria, is frequently required.
骨髓移植（B.M.T.）后血尿的鉴别诊断可能包括多瘤病毒（BK和JC）相关的出血性膀胱炎。许多报告表明BK病毒是BMT后出血性膀胱炎发生的主要病原体。BK病毒尿症也与肾移植受者的输尿管狭窄有关。病毒性尿路感染在健康个体中并不常见，但在免疫抑制状态的患者中却很常见。
对1995年至2000年期间连续123例B.M.T.受者进行回顾性研究，评估那些患有多瘤病毒相关出血性膀胱炎的患者。我们展示了这些“尿路隐藏宿主”的患者特征、原发性疾病、临床特征、诊断方面和治疗情况。
7例患者（占B.M.T.的5.7%）发生了BK或JC病毒相关的出血性膀胱炎；3名男性和4名女性；患者中位年龄为29岁（范围14至45岁）。所有患者的细菌、分枝杆菌和寄生虫尿液培养结果均为阴性。临床病程的特点是出血性膀胱炎发病较晚（BMT后30至132天）。所有7例患者均出现肉眼血尿（持续时间3至30天）。6例符合移植物抗宿主病（G.V.H.D.）标准。超声检查显示5例患者膀胱壁弥漫性增厚。血尿的处理方法包括水化、输血、经尿道置管和清除血凝块、持续膀胱冲洗、尿液碱化和抗病毒治疗。无需采取其他更积极的措施来止血。仅1例患者肌酐短暂升高。
在骨髓移植受者血尿的鉴别诊断中必须考虑多瘤病毒相关的出血性膀胱炎。根据血尿的严重程度和持续时间，通常需要进行泌尿外科处理。
