Nickeleit Volker, Singh Harsharan K, Mihatsch Michael J
Department of Pathology, Nephropathology Laboratory, The University of North Carolina, Chapel Hill, North Carolina 27599-7525, USA.
Curr Opin Nephrol Hypertens. 2003 Nov;12(6):599-605. doi: 10.1097/00041552-200311000-00005.
Viral nephropathies, particularly those caused by polyomaviruses of the BK-virus strain, are serious complications following renal transplantation. The review will highlight the morphological, pathophysiological and clinical aspects of BK-virus nephropathy. New patient management strategies are discussed.
Immunosuppression with tacrolimus and mycophenolate-mofetil promotes the activation of latent BK-virus in the urinary tract and increases the odds ratio for developing BK-virus nephropathy significantly. A productive infection with BK-viruses shows viral replication in tubular epithelial cells and acute tubular injury. BK-virus nephropathy can be further complicated by concurrent acute rejection episodes contributing to graft demise. Risk assessment after transplantation and patient management during ongoing viral nephropathy have undergone revision by the introduction of real time quantitative polymerase chain reaction techniques measuring BK-virus genome load fluctuations in the serum. Treatment strategies for BK-virus nephropathy include not only low-dose immunosuppression but also drugs with antiviral effects: cidofovir and leflunomide. Transient anti-rejection therapy, including anti-lymphocytic preparations, is a therapeutic option in cases of BK-virus nephropathy and concurrent acute rejection. Recent advances in patient management strategies have resulted in markedly improved graft survival. In cases of graft loss due to BK-virus nephropathy, re-transplantation should be considered.
BK-virus nephropathy is a significant complication following renal transplantation. Recent advances have improved our understanding of the morphological changes, potential risk factors and patient management strategies would be optimized. The availability of quantitative viral load measurements now offers the opportunity for a more accurate and timely clinical intervention.
病毒性肾病，尤其是由BK病毒株的多瘤病毒引起的肾病，是肾移植后的严重并发症。本综述将重点介绍BK病毒肾病的形态学、病理生理学和临床方面。并讨论新的患者管理策略。
使用他克莫司和霉酚酸酯进行免疫抑制会促进泌尿道中潜伏BK病毒的激活，并显著增加发生BK病毒肾病的几率。BK病毒的有效感染表现为肾小管上皮细胞中的病毒复制和急性肾小管损伤。BK病毒肾病可能会因并发急性排斥反应而进一步复杂化，从而导致移植肾失功。通过引入实时定量聚合酶链反应技术来测量血清中BK病毒基因组负荷波动，移植后的风险评估和正在发生病毒性肾病期间的患者管理已经得到修订。BK病毒肾病的治疗策略不仅包括低剂量免疫抑制，还包括具有抗病毒作用的药物：西多福韦和来氟米特。在BK病毒肾病并发急性排斥反应的情况下，包括抗淋巴细胞制剂在内的短暂抗排斥治疗是一种治疗选择。患者管理策略的最新进展已使移植肾存活率显著提高。在因BK病毒肾病导致移植肾丢失的情况下，应考虑再次移植。
BK病毒肾病是肾移植后的一种重要并发症。最近的进展增进了我们对其形态学变化、潜在危险因素的理解，患者管理策略也将得到优化。定量病毒载量测量的可用性现在为更准确、及时的临床干预提供了机会。
