Pediatric Nephrology

, Volume 26, Issue 10, pp 1763–1774

The BK virus in renal transplant recipients—review of pathogenesis, diagnosis, and treatment

Authors

    • Division of Pediatric NephrologyUniversity of Florida College of Medicine & Shands Children’s Hospital
  • Husam A. Abdulnour
    • Division of Pediatric NephrologyUniversity of Florida College of Medicine & Shands Children’s Hospital
  • Carlos E. Araya
    • Division of Pediatric NephrologyUniversity of Florida College of Medicine & Shands Children’s Hospital
Review

DOI: 10.1007/s00467-010-1716-6

Cite this article as:
Dharnidharka, V.R., Abdulnour, H.A. & Araya, C.E. Pediatr Nephrol (2011) 26: 1763. doi:10.1007/s00467-010-1716-6

Abstract

The BK virus, a DNA virus from the Polyomavirus group, represents an opportunistic infection of immunosuppressed transplant recipients. Though the virus was discovered approximately 40 years ago, the emergence of BK virus nephropathy since 1995 onwards, with associated high graft loss rates, has revolutionized renal transplantation medicine. Kidney transplant professionals realized that the consequences of over-immunosuppression were as severe as the consequences of under-immunosuppression and we entered the era of immunosuppressive minimization. Despite this recognition, the optimal testing type for BK virus infections and frequency of testing are hotly debated. Similarly, optimal treatment strategies remain sources of intense controversy. The authors review the current strategies of screening, diagnosis, and possible treatment, and also review the amount and quality of evidence in favor or against. Similarities and differences between cytomegalovirus, Epstein-Barr virus, and BV virus, the three major viral infections in kidney transplantation, are highlighted.

Keywords

BK VirusPolyoma virusBK virus allograft nephropathyPCR testingCidofovirLeflunomideKidney transplantChildren

Abbreviations

BKV

BK virus

CMV

Cytomegalovirus

EBV

Epstein–Barr virus

BKVN

BK virus nephropathy

UNOS/OPTN

United Network of Organ Sharing/Organ Procurement and Transplant Network

KDIGO

Kidney Disease Improving Global Outcomes

AST

American Society of Transplantation

PPV

Positive predictive value

NPV

Negative predictive value

Copyright information

© IPNA 2010