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Polyomanephropathie nach Nierentransplantation

Polyoma virus nephropathy after kidney transplantation

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Die Polyomanephropathie (BKV-Nephropathie) ist eine bekannte Komplikation nach Organtransplantation. Sie tritt interessanterweise nur nach Nierentransplantation auf und führt zu einer Funktionsverschlechterung bis hin zum Transplantatverlust. Der Artikel beschreibt Epidemiologie, Pathogenese und das genaue Management der Polyomavirusreplikation und der Polyomanephropathie. Da es keine spezifische Therapie gibt, muss die Diagnose früh erfolgen. Dies erreicht man mit einem stufenweisen Vorgehen. Als Grundlage dient die regelmäßige Untersuchung des Urins auf Decoy-Zellen. Alternativ kann auch eine BKV-PCR des Urins erfolgen. Beide Untersuchungen weisen die Replikation des Polyomavirus im Urogenitaltrakt nach. Fällt dieser Test positiv aus, muss die Viruslast mittels BKV-PCR im Blut gemessen werden. Bei einer erhöhten Viruslast (>4 log10 Kopien pro ml) erfolgt ohne weitere Diagnostik die sofortige Reduktion der Immunosuppression. Durch Kontrollen der Viruslast im Blut wird der Therapieerfolg abgeschätzt und bei Bedarf die Therapie weiter angepasst. Erst bei einer Funktionsverschlechterung oder fehlendem Absinken der Viruslast muss eine Biopsie durchgeführt werden.

Abstract

Polyoma virus nephropathy is a well-known complication after organ transplantation. Interestingly it is almost exclusively seen after kidney transplantation and can lead to impaired kidney function and graft loss. This article describes the epidemiology, pathogenesis as well as the detailed management of polyoma virus replication and polyoma virus nephropathy. Because there is no established antiviral therapy, diagnosis has to be made early in the course of polyma virus nephropathy, ideally when the polyoma virus initiates replication. The periodical analysis of decoy cells in the urine is the base of the screening method or alternatively BK virus (BKV) PCR can be performed on urine. Both tests have the goal to demonstrate polyoma virus replication in the urogenital tract. If viral replication is demonstrated the viral load in the blood has to be analyzed. In cases of an elevated viral load (> 4 log10 copies/ml) immunosuppression has to be reduced without further diagnostics. Success of the therapy procedure has to be controlled by periodical analysis of viral load in the blood. An allograft biopsy only has to be performed in cases of impaired renal function or lack of a decline of viral load.

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  1. Klinik für Transplantationsimmunologie und Nephrologie, Universitätsspital Basel, Petersgraben 4/6, CH-4031, Basel, Schweiz

    J.U. Steiger

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  1. J.U. Steiger
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Correspondence to J.U. Steiger.

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Steiger, J. Polyomanephropathie nach Nierentransplantation. Nephrologe 7, 314–318 (2012). https://doi.org/10.1007/s11560-011-0630-7

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  • DOI: https://doi.org/10.1007/s11560-011-0630-7

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