Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Nat Rev Nephrol. 2012 Apr 17;8(7):390-402. doi: 10.1038/nrneph.2012.64.
Polyomavirus-associated nephropathy (PVAN) remains an important infectious complication after renal transplantation, affecting 1-10% of recipients and causing graft loss in approximately 50% of cases. With the lack of effective antiviral therapy, intensive monitoring for BK virus (BKV) using nucleic acid testing or urine cytology--in combination with a reduction of immunosuppressive therapy--is advocated to detect and prevent BKV reactivation and PVAN, respectively. In this Review, new insights into BKV biology and the development of PVAN are discussed. Clinical diagnostic approaches for the detection, surveillance and therapeutic monitoring of BKV are described. In addition, various strategies for reduction of immunosuppressive therapy are reviewed and an evaluation provided of the mechanisms of action and clinical effects of currently used adjuvant medication such as cidofovir, leflunomide, intravenous immunoglobulins and fluoroquinolone antibiotics. Finally, novel compounds and their in vitro actions against BKV are discussed together with future prospects for specific antiviral drug development.
多瘤病毒相关性肾病 (PVAN) 仍是肾移植后的一个重要感染性并发症，影响 1-10%的受者，约 50%的病例导致移植物丢失。由于缺乏有效的抗病毒治疗，提倡使用核酸检测或尿液细胞学检测来对 BK 病毒 (BKV) 进行强化监测，以分别检测和预防 BKV 再激活和 PVAN。在这篇综述中，讨论了 BKV 生物学和 PVAN 发展的新见解。描述了用于检测、监测和治疗性监测 BKV 的临床诊断方法。此外，还回顾了减少免疫抑制治疗的各种策略，并评价了目前使用的辅助药物（如更昔洛韦、来氟米特、静脉注射免疫球蛋白和氟喹诺酮类抗生素）的作用机制和临床效果。最后，讨论了针对 BKV 的新型化合物及其体外作用，并对特定抗病毒药物开发的未来前景进行了展望。
