Matossian Debora, Langman Craig B, Cohn Richard A, Ali Farah N
Kidney Diseases Division, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL 60614, USA.
Pediatr Transplant. 2012 Nov;16(7):729-34. doi: 10.1111/j.1399-3046.2012.01732.x. Epub 2012 Jun 7.
BKVN leads to allograft dysfunction following kidney transplantation and is preceded by BK viremia. Studies in pediatric kidney transplant recipients reveal an incidence of viruria ranging from 18% to 33%, viremia 6-16%, and BKVN 2-8%. Specific risk factors have not been clearly elucidated. Retrospective chart review of pediatric kidney transplants performed from January 2005 through December 2009; to identify risk factors associated with BK viremia in pediatric kidney transplant recipients from a single center. Of the 93 patients who received kidney transplants in the study period, 22 (24%) developed BK viruria, including 12 (13%) who developed viremia. One patient with viremia (1.6%) had BKVN. Obstructive uropathy was identified as the cause of ESKD in 22 (24%) of all recipients. 27% (n = 6) of these 22 patients developed viremia, while only 8.5% (6/71) with ESKD from another cause had viremia (p = 0.001). No other examined variable differed between the two groups. Although the overall incidence was no higher than other reported series, we identified that BK disease was more frequent in children with OU. A higher index of suspicion for invasive BK disease is necessary in patients with OU who receive kidney allografts. Transplant protocols may need to consider underlying cause of ESKD when designing screening protocols for BK disease in children after kidney transplantation.
BK病毒相关性肾病（BKVN）可导致肾移植后移植肾失功，且在此之前会出现BK病毒血症。对小儿肾移植受者的研究显示，病毒尿的发生率为18%至33%，病毒血症为6%至16%，BKVN为2%至8%。具体的危险因素尚未明确阐明。对2005年1月至2009年12月期间进行的小儿肾移植进行回顾性病历审查；以确定单中心小儿肾移植受者中与BK病毒血症相关的危险因素。在研究期间接受肾移植的93例患者中，22例（24%）出现BK病毒尿，其中12例（13%）出现病毒血症。1例病毒血症患者（1.6%）发生了BKVN。在所有受者中，22例（24%）被确定梗阻性尿路病是终末期肾病（ESKD）的病因。这22例患者中有27%（n = 6）出现病毒血症，而因其他原因导致ESKD的患者中只有8.5%（6/71）出现病毒血症（p = 0.001）。两组之间其他检查变量无差异。尽管总体发生率不高于其他报道系列，但我们发现OU患儿中BK疾病更为常见。对于接受肾移植的OU患者，需要对侵袭性BK疾病有更高的怀疑指数。在设计小儿肾移植后BK疾病的筛查方案时，移植方案可能需要考虑ESKD的潜在病因。
