Bonvoisin C, Krzesinski J M
Centre Hospitalier Universitaire de Liège, ULg.
Rev Med Liege. 2005 Oct;60(10):775-82.
Beside acute rejection or immunosuppressive therapy toxicity, infection by Polyomavirus BK, usually not aggressive in immunoactive patients, has emerged as an important factor affecting graft function in renal transplant recipients. Indeed, one of the most important complications of BK infection is nephropathy. Viral replication in the urinary tract as assessed by the presence of "decoy cells", or by a positive PCR for BK virus has been detected in up to half of the recipients but only 5% will present nephropathy which is usually the only sign. The most common risk factors for this emerging new cause are new immunosuppressive drugs and rejection episodes. The gold standard to diagnose BK nephropathy is immunohistochemical staining for large T antigen in graft biopsy specimens. Urine cytology examination and DNA BK PCR are used as a screening test. The prognosis in BK nephropathy has been considered to be poor. The early reduction of immunosuppression can improve the prognosis and perhaps also cidofovir or leflunomide use.
除了急性排斥反应或免疫抑制治疗毒性外，多瘤病毒BK感染在免疫活性患者中通常并不具有侵袭性，但已成为影响肾移植受者移植肾功能的一个重要因素。事实上，BK感染最重要的并发症之一是肾病。通过“诱饵细胞”的存在或BK病毒PCR检测呈阳性评估的尿路病毒复制，在多达一半的受者中被检测到，但只有5%的人会出现肾病，而肾病通常是唯一的症状。这种新出现病因的最常见危险因素是新型免疫抑制药物和排斥反应。诊断BK肾病的金标准是移植活检标本中针对大T抗原的免疫组化染色。尿细胞学检查和BK DNA PCR用作筛查试验。BK肾病的预后一直被认为很差。早期减少免疫抑制可改善预后，或许还可使用西多福韦或来氟米特。
