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https://www.readbyqxmd.com/read/28538243/bk-virus-as-a-mediator-of-graft-dysfunction-following-kidney-transplantation
#1
Stephanie G Yi, Richard J Knight, Keri E Lunsford
PURPOSE OF REVIEW: BK virus is a significant risk factor for kidney allograft dysfunction and loss among renal transplant recipients. Currently, there is no proven effective treatment except for the reduction of immunosuppression. In this review, we discuss diagnostic challenges and current treatment options for BK in kidney transplant recipients. RECENT FINDINGS: Antiviral and antibiotic therapies have been employed for BK viraemia with variable efficacy. In addition, novel therapeutic regimens such as adoptive transfer of targeted T cells have been described as possible treatment options for recipients with BK nephropathy...
May 22, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28536123/randomized-controlled-trial-of-mineralocorticoid-receptor-blockade-in-children-with-chronic-kidney-allograft-nephropathy
#2
Mara Medeiros, Luis Velásquez-Jones, Ana M Hernández, Guillermo Ramón-García, Saúl Valverde, Yolanda Fuentes, Arindal Vargas, Mauricio Patiño, Rosalba Pérez-Villalva, Juan Antonio Ortega-Trejo, Jonatan Barrera-Chimal, Norma A Bobadilla
BACKGROUND AND OBJECTIVES: We showed that mineralocorticoid receptor blockade (MRB) prevented acute and chronic cyclosporine nephropathy (CsA-Nx) in the rat. The aim of this translational study was to investigate the effect of long-term eplerenone administration on renal allograft function in children with biopsy-proven chronic allograft nephropathy (CAN). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Renal transplant children <18 years, biopsy-proven CAN, and a GFR>40 ml/min per 1...
May 23, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28535782/bk-polyomavirus-nephropathy-in-two-kidney-transplant-patients-with-distinct-diagnostic-strategies-for-bk-virus-and-similar-clinical-outcomes-two-case-reports
#3
Ana Luisa Figueira Gouvêa, Rachel Ingrid Juliboni Cosendey, Ana Lucia Rosa Nascimento, Fabiana Rabe Carvalho, Andrea Alice Silva, Heleno Pinto de Moraes, Mayra Carrijo Rochael, Rafael Brandão Varella, Stephanie Gomes Almeida, Jorge Reis Almeida, Jocemir Ronaldo Lugon
BACKGROUND: BK polyomavirus-associated nephropathy is an important cause of post-transplantation renal failure. We present two cases of BK polyomavirus-associated nephropathy who were submitted to contrasting strategies of clinical follow-up to BK polyomavirus reactivation, but progressed to a similar final outcome. CASE PRESENTATION: Case 1 is a 37-year-old white man whose graft had never presented a good glomerular filtration rate function, with episodes of tacrolimus nephrotoxicity, and no urinary monitoring for BK polyomavirus; stage B BK polyomavirus-associated nephropathy was diagnosed by biopsy at 14 months post-transplant...
May 24, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28535528/chronic-allograft-injury-an-overview-of-pathogenesis-and-treatment-strategies
#4
Hector M Madariaga, Leonardo V Riella
Chronic allograft injury (CAI) remains one of the biggest challenges in transplantation as it directly affects the long-term allograft survival, an area in which the scientific and transplantation communities have struggled to improve outcomes. Therefore, understanding the mechanisms of CAI is paramount to implement preventive measures and novel therapeutic options. In this review, we will address the latest evidence on CAI, potential etiologies and risk factors including non-adherence, antibody-mediated rejection, recurrence of glomerular disease, BK nephropathy, and calcineurin nephrotoxicity...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28532495/development-and-validation-of-the-angiotensin-converting-enzyme-inhibitor-acei-induced-angioedema-investigator-rating-scale-and-proposed-discharge-criteria
#5
Nicola Bonner, Charlotte Panter, Alan Kimura, Rich Sinert, Joseph Moellman, Jonathan A Bernstein
BACKGROUND: The use of angiotensin-converting enzyme inhibitors (ACEI) has been associated with the development of bradykinin-mediated angioedema. With ever-widening indications for ACEI in diseases including hypertension, congestive heart failure and diabetic nephropathy, a concomitant increase in ACEI-Angioedema (ACEI-A) has been reported. At present there is no validated severity scoring or discharge criteria for ACEI-A. We sought to develop and validate an investigator rating scale with corresponding discharge criteria using clinicians experienced in treating ACEI-A...
May 22, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28512328/tacrolimus-blood-level-fluctuation-predisposes-to-coexisting-bk-virus-nephropathy-and-acute-allograft-rejection
#6
Chia-Lin Shen, An-Hang Yang, Tse-Jen Lien, Der-Cherng Tarng, Chih-Yu Yang
BK virus nephropathy (BKVN) and allograft rejection are two distinct disease entities which occur at opposite ends of the immune spectrum. However, they coexist in renal transplant recipients. Predisposing factors for this coexistence remain elusive. We identified nine biopsy-proven BKVN patients with coexisting acute rejection, and 21 patients with BKVN alone. We retrospectively analyzed the dosage and blood concentrations of immunosuppressants during the 3-month period prior to the renal biopsy between the two patient groups...
May 16, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28510315/bk-virus-nephropathy-revisited
#7
EDITORIAL
Michael Mengel
More than 20 years after its first description and increased morbidity under powerful immunosuppression, the understanding of the pathogenesis of BK polyomavirus induced allograft nephropathy (BKVN) has changed clinical practice in renal transplantation. Screening programs were introduced at most transplant centers causing the prevalence of BKVN to decrease. However, BK viremia is still found in 10-30% of renal allograft recipients with 1-10% developing BKVN. This article is protected by copyright. All rights reserved...
May 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28509373/bk-viremia-surveillance-and-outcomes-in-simultaneous-pancreas-kidney-transplant-recipients
#8
Scott G Westphal, Elizabeth R Lyden, Eric D Langewisch, Clifford D Miles
BACKGROUND: While screening for asymptomatic BK viremia (BKV) has been well studied in isolated kidney transplant recipients, there is a paucity of published outcomes in simultaneous pancreas-kidney (SPK) transplant recipients who underwent BKV screening followed by pre-emptive reduction of immunosuppression. METHODS: This is a single-center, retrospective review of 31 consecutive SPK recipients who were transplanted over a five year period following the initiation of a serum BKV screening protocol...
May 16, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28492728/evaluation-of-the-predisposition-and-clinical-impact-of-bk-virus-replication-in-kidney-transplant-patients
#9
Elviani B Moura, Silvia V Petzhold, Augusto R Amaral, Luciane M Deboni, Paulo H C DE França
The BK virus (BKV) produces a subclinical kidney infection in immunocompetent individuals. However, viremia may occur in kidney transplant patients with ongoing immunosuppression. BKV-associated nephropathy (BKVN) has no specific treatment and is a leading cause of organ transplant loss. In this study, we evaluated the predisposition and the clinical impact of BKV replication in kidney transplant patients during post-transplant monitoring in a reference institution in Brazil. Demographic, clinical and laboratory data generated during routine outpatient follow-up were retrospectively collected...
May 4, 2017: Anais da Academia Brasileira de Ciências
https://www.readbyqxmd.com/read/28460546/an-update-on-chemical-pharmacotherapy-options-for-the-prevention-of-kidney-transplant-rejection-with-a-focus-on-costimulation-blockade
#10
Florian Kälble, Matthias Schaier, Sebastian Schäfer, Caner Süsal, Martin Zeier, Claudia Sommerer, Christian Morath
The introduction of calcineurin inhibitors (CNI) has greatly improved graft survival in the past three decades. However, long-term graft survival is still limited due to chronic allograft injury and side-effects of immunosuppressive medication. Areas covered: The present overview gives an update on pharmacotherapeutic strategies after kidney transplantation. The main focus is on CNI-sparing regimens using co-stimulatory blockade and on new substances on the horizone. Expert opinion: CNI sparing regimens are well-established...
June 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28422412/histological-evolution-of-bk-virus-associated-nephropathy-importance-of-integrating-clinical-and-pathological-findings
#11
Cinthia B Drachenberg, John C Papadimitriou, Muhammad R Chaudhry, Richard Ugarte, Manju Mavanur, Beje Thomas, Charles Cangro, Nadiesda Costa, Emilio Ramos, Matthew R Weir, Abdolreza Haririan
Long term clinicopathological studies of BK-associated nephropathy (PyVAN) are not available. We studied 206 biopsies (71 patients), followed 3.09±1.46y after immunosuppression reduction. The biopsy features (% SV40+staining and inflammation +/- acute rejection) were correlated with viral load dynamics and serum creatinine to define the clinicopathological status (PyVCPS). Incidence of acute rejection was 28% in the 2(nd) biopsy and 50% subsequently (25% mixed TCMR+AMR; rejection overall affected 38% of patients (>50% AMR)...
April 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28405598/clearance-of-bk-virus-nephropathy-by-combination-antiviral-therapy-with-intravenous-immunoglobulin
#12
Kathy Kable, Carmen D Davies, Philip J O'connell, Jeremy R Chapman, Brian John Nankivell
BACKGROUND: Reactivation of BK polyoma virus causes a destructive virus allograft nephropathy (BKVAN) with graft loss in 46%. Treatment options are limited to reduced immunosuppression and largely ineffective antiviral agents. Some studies suggest benefit from intravenous immunoglobulin (IVIG). METHODS: We evaluated effectiveness of adjuvant IVIG to eliminate virus from blood and tissue, in a retrospective, single-center cohort study, against standard-of-care controls...
April 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28390948/relationship-of-angiotensin-i-converting-enzyme-ace-and-bradykinin-b2-receptor-bdkrb2-polymorphism-with-diabetic-nephropathy
#13
Honghong Zou, Guoqing Wu, Jinlei Lv, Gaosi Xu
PURPOSE: To determine whether ACE(2) I/D and BDKRB2(3) +9/-9 polymorphism causatively affect diabetic nephropathy progression RESULTS: STZ-induced metabolic disorder, as well as inflammatory responses, was significantly aggravated in ACE II-B2R(4)+9bp, ACE DD-B2R+9bp, or ACE DD-B2R-9bp diabetic mice but not ACE II-B2R-9bp, indicating the genetic susceptibility of ACE DD or B2R+9bp to diabetic nephropathy. Furthermore, ACE II-B2R+9bp, ACE DD-B2R+9bp, or ACE DD-B2R-9bp rather than ACE II-B2R-9bp, worsened renal performance and enhanced pathological alterations induced by STZ...
April 5, 2017: Biochimica et Biophysica Acta
https://www.readbyqxmd.com/read/28371308/bk-virus-nephropathy-histological-evolution-by-sequential-pathology
#14
B J Nankivell, J Renthawa, R N Sharma, K Kable, P J O'Connell, J R Chapman
Reactivation of BK virus in renal allografts causes a destructive chronic infection. This single-center retrospective cohort study describes the evolution of BK virus allograft nephropathy (BKVAN) from 63 kidneys (from 61 patients) using sequential histopathology (454 biopsies, averaging 7.8 ± 2.6 per kidney) followed for 60.1 mo. Uninfected protocol biopsies formulated time-matched control Banff scores (n = 975). Interstitial inflammation occurred in 73% at diagnosis, correlating with viral histopathology (r = 0...
March 30, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28355579/stability-of-bk-polyomavirus-igg-seroreactivity-and-its-correlation-with-preceding-viremia
#15
Herman F Wunderink, Els van der Meijden, Caroline S van der Blij-de Brouwer, Hans L Zaaijer, Aloys C M Kroes, Erik W van Zwet, Joris I Rotmans, Mariet C W Feltkamp
BACKGROUND: Recently we showed that the level of BK polyomavirus (BKPyV) IgG seroreactivity in kidney donors predicted viremia and BKPyV-associated nephropathy in kidney transplant recipients (KTRs). This observation could be explained by assuming a direct association between BKPyV seroreactivity and the amount of persistent infectious virus in the renal allograft. OBJECTIVES: Since the renal BKPyV reservoir is probably sowed by viremia during primary BKPyV infection, we systematically analysed the dynamics of BKPyV IgG seroreactivity in relation to preceding BKPyV viremia in KTRs and healthy individuals...
March 19, 2017: Journal of Clinical Virology: the Official Publication of the Pan American Society for Clinical Virology
https://www.readbyqxmd.com/read/28340828/prevalence-and-risk-factors-of-bk-viremia-in-patients-with-kidney-transplantation-a-single-center-experience-from-turkey
#16
S E Dogan, Z K Celebi, S Akturk, S Kutlay, A Tuzuner, K Keven, S Sengul
BACKGROUND: BK virus is the cause of nephropathy, which can progress to graft loss after kidney transplantation. In this study, we aimed to investigate the prevalence and risk factors of BK viremia in patients with kidney transplantation at our center. METHODS: This was a retrospective single-center study. We included recipients transplanted between 2010 and 2015. Patients were stratified according to BK virus DNA follow-up values into three groups (0-999 copies/mL, 1000-9999 copies/mL and ≥10,000 copies/mL)...
April 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28340806/average-tacrolimus-trough-level-in-the-first-month-after-transplantation-may-predict-acute-rejection
#17
S Aktürk, Ş Erdoğmuş, G Kumru, A H Elhan, Ş Şengül, A Tüzüner, K Keven
BACKGROUND: Although tacrolimus is one of the essential drugs used for the prevention of rejection in kidney recipients, target trough levels are not well established. In this study, we aimed to investigate the association between average tacrolimus trough levels (TTLs) of the first month after transplantation and biopsy-proven acute rejection (BPAR) during the first 12 months after transplant. METHODS: A total of 274 patients who underwent kidney-alone transplantation between 2002 and 2014 were enrolled in the study...
April 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28298471/bk-polyomavirus-clinical-aspects-immune-regulation-and-emerging-therapies
#18
REVIEW
George R Ambalathingal, Ross S Francis, Mark J Smyth, Corey Smith, Rajiv Khanna
BK polyomavirus (BKV) causes frequent infections during childhood and establishes persistent infections within renal tubular cells and the uroepithelium, with minimal clinical implications. However, reactivation of BKV in immunocompromised individuals following renal or hematopoietic stem cell transplantation may cause serious complications, including BKV-associated nephropathy (BKVAN), ureteric stenosis, or hemorrhagic cystitis. Implementation of more potent immunosuppression and increased posttransplant surveillance has resulted in a higher incidence of BKVAN...
April 2017: Clinical Microbiology Reviews
https://www.readbyqxmd.com/read/28295760/variability-in-assessing-for-bk-viremia-whole-blood-is-not-reliable-and-plasma-is-not-above-reproach-a-retrospective-analysis
#19
Neerja Agrawal, Ignacio A Echenique, Shane M Meehan, Ajit P Limaye, Linda Cook, Anthony Chang, Robert C Harland, Basit Javaid, Pradeep V Kadambi, Scott Matushek, James Williams, Michelle A Josephson
Polyomavirus nephropathy (PVN) is a major complication of kidney transplantation. Most reports describe polyomavirus viremia either precedes or is detectable at the time of diagnosis of PVN. This association is the basis of current screening recommendations. We retrospectively reviewed the PCR results of blood and urine samples from 29 kidney transplant recipients with biopsy proven PVN. Biopsies were performed for a rise in serum creatinine or persistent high-level BK viruria. All biopsies had polyoma virus large T-antigen expression in tubular epithelium by immunohistochemistry...
March 14, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28273393/a-retrospective-study-to-describe-the-epidemiology-and-outcomes-of-opportunistic-infections-after-abdominal-organ-transplantation
#20
Mia Helfrich, Peter Dorschner, Kathryn Thomas, Valentina Stosor, Michael G Ison
BACKGROUND: Most epidemiologic studies of opportunistic infections (OI) following abdominal organ transplantation are derived prior to the era of contemporary immunosuppression and prophylaxis. These studies suggest that most OI occur within the first 6 months post transplant. METHOD: In this single-center, retrospective cohort study, we describe the epidemiology of OI in 359 consecutive abdominal organ transplant recipients, in the era of contemporary prophylaxis practices and alemtuzumab induction in kidney and simultaneous pancreas-kidney transplant recipients...
March 8, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
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