Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, I.R. of Iran.
Educated of Tehran University of Medical Sciences, Tehran, I.R. of Iran.
BMC Nephrol. 2021 Jun 18;22(1):226. doi: 10.1186/s12882-021-02444-5.
Early diagnosis and treatment of Polyomavirus BK Nephropathy (PVBKN) is a challenging issue in the management of patients with kidney transplantation. Currently, histopathologic diagnosis is the gold standard method for diagnosis of PVBKN. However, typical viral inclusions may not be found in early stages of the PVBKN and should, instead, be diagnosed using immunohistochemistry (IHC) study. There is no clear consensus about routine IHC tests in the pathologic evaluation of transplanted kidney biopsy samples.
The current study was conducted on transplanted kidney biopsy samples, since 2016 to 2019. The patients who have presented with new onset of allograft dysfunction, at least 2 weeks after transplantation surgery, were included in our study. All these biopsy samples were evaluated with routine renal biopsy stains as well as IHC for SV40 (Simvian Virus 40) antigen. The identification of typical nuclear virus inclusion body and any nuclear positive staining on IHC (≥1+ positive result) were considered as definite evidence of PVBKN. Sensitivity, specificity, Positive Predictive and Negative Predictive Values (PPV and NPV) of histopathologic assessment without IHC study were evaluated.
Among 275 included cases, 18 (6.5%) patients with PVBKN were diagnosed. In patients with PVBKN, typical viral inclusions were detected in 14 samples (77.7%), on primary histopathological examination. However, virus-infected cells were identified just after IHC study in 4 (22.2%) of patients. Sensitivity, Specifity, PPV and NPV of morphologic histopathological assay without IHC for detection of PVBKN was 77.7, 100, 100 and 98.4% respectively.
Routine IHC study for SV40 in all transplanted kidney biopsy samples with new onset of allograft dysfunction, will enhance the diagnostic sensitivity of early stage disease detection.
在肾移植患者的管理中，早期诊断和治疗多瘤病毒 BK 肾病（PVBKN）是一个具有挑战性的问题。目前，组织病理学诊断是诊断 PVBKN 的金标准方法。然而，在 PVBKN 的早期阶段可能找不到典型的病毒包涵体，而应该通过免疫组织化学（IHC）研究来诊断。在移植肾活检样本的病理评估中，是否常规进行 IHC 检测尚无明确共识。
本研究于 2016 年至 2019 年对移植肾活检样本进行了研究。本研究纳入了自移植手术后至少 2 周出现新的移植物功能障碍的患者。所有这些活检样本均通过常规肾活检染色以及 SV40（Simvian Virus 40）抗原的 IHC 进行评估。典型核病毒包涵体的鉴定和 IHC 上的任何核阳性染色（≥1+阳性结果）被认为是 PVBKN 的明确证据。评估了不进行 IHC 研究的组织病理学评估的敏感性、特异性、阳性预测值和阴性预测值（PPV 和 NPV）。
在 275 例纳入的病例中，18 例（6.5%）患者被诊断为 PVBKN。在 PVBKN 患者中，14 例（77.7%）在初次组织病理学检查中发现典型病毒包涵体。然而，在 4 例（22.2%）患者中，仅在 IHC 研究后才发现受感染的细胞。形态学组织病理学检测不进行 IHC 检测 PVBKN 的敏感性、特异性、PPV 和 NPV 分别为 77.7%、100%、100%和 98.4%。
对新发移植物功能障碍的所有移植肾活检样本常规进行 SV40 的 IHC 研究，将提高早期疾病检测的诊断敏感性。
