Araya Carlos E, Lew Judy F, Fennell Robert S, Neiberger Richard E, Dharnidharka Vikas R
Divisions of Pediatric Nephrology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.
Pediatr Transplant. 2008 Nov;12(7):790-5. doi: 10.1111/j.1399-3046.2008.00937.x. Epub 2008 May 31.
BKVAN has emerged as a major morbidity in kidney transplant recipients. Among treatment options is cidofovir, which can be nephrotoxic. We previously reported that intermediate dose cidofovir could be used without significant nephrotoxicity. We present extended results of the same treatment protocol in a larger cohort and with longer follow up. Diagnosis of BKVAN was based on detection of BK viral DNA from plasma and renal allograft biopsy tissue. All patients received cidofovir (0.25-1 mg/kg/dose) every 2-3 wk. Total number of cidofovir doses ranged from 1 to 18 (mean 8). This report includes eight patients, aged 5-21 yr, treated with intermediate dose cidofovir. Median follow-up was 11 months (range 4-32). Mean fall in reciprocal of serum creatinine (1/sCr) from baseline at BKVAN diagnosis was 64% (range 28-120%). A time-series plot of plasma BK virus PCR and 1/sCr showed marked reduction in viral loads without significant deterioration in 1/sCr from the initial value at BKVAN diagnosis. In this larger series with extended follow up, intermediate dose cidofovir without probenecid for the treatment of BKVAN continues to show stabilization of renal function without progression to renal failure.
BK病毒相关性肾病已成为肾移植受者的一种主要发病情况。治疗选择之一是西多福韦，但它可能具有肾毒性。我们之前报道过，中等剂量的西多福韦可以使用且不会产生明显的肾毒性。我们在此展示了同一治疗方案在更大队列且随访时间更长情况下的扩展结果。BK病毒相关性肾病的诊断基于血浆和肾移植活检组织中BK病毒DNA的检测。所有患者每2至3周接受一次西多福韦治疗（0.25 - 1毫克/千克/剂量）。西多福韦的总剂量范围为1至18次（平均8次）。本报告纳入了8名年龄在5至21岁之间、接受中等剂量西多福韦治疗的患者。中位随访时间为11个月（范围4至32个月）。在BK病毒相关性肾病诊断时，血清肌酐倒数（1/sCr）相对于基线的平均下降幅度为64%（范围28%至120%）。血浆BK病毒PCR和1/sCr的时间序列图显示，病毒载量显著降低，且1/sCr自BK病毒相关性肾病诊断时的初始值起无明显恶化。在这个随访时间更长的更大系列研究中，不使用丙磺舒的中等剂量西多福韦治疗BK病毒相关性肾病持续显示出肾功能稳定，未进展至肾衰竭。
