Chinese Journal of Tissue Engineering Research ›› 2012, Vol. 16 ›› Issue (40): 7411-7416.doi: 10.3969/j.issn.2095-4344.2012.40.001

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BK virus associated nephropathy after kidney transplantation

BK virus associated nephropathy after kidney transplantation   

  1. Chinese PLA Research Institute of Nephrology, Nanjing General Hospital of Chinese PLA in Nanjing Military Region, Clinical Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
  • Received:2011-10-08 Revised:2011-11-02 Online:2012-09-30 Published:2012-09-30
  • Contact: Liu Zhi-hong, Academician, Doctoral supervisor, Chinese PLA Research Institute of Nephrology, Nanjing General Hospital of Chinese PLA in Nanjing Military Region, Clinical Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China zhihong-liu@ hotmail.com
  • About author:Ji Shu-ming, Chief physician, Chinese PLA Research Institute of Nephrology, Nanjing General Hospital of Chinese PLA in Nanjing Military Region, Clinical Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China jishuming@medmail.com.cn

Abstract:

BACKGROUND: Polyomavirus infection is an important cause of BK virus associated nephropathy (BKVAN) and renal allograft dysfunction.
OBJECTIVE: To investigate pathological features and clinical characteristics of BKVAN.
METHODS: Polyomavirus large T antigen staining of 121 transplant renal biopsy showed that nine cases were positively diagnosed as having BKVAN. Clinical, pathologic, immunofluorescence and immunohistochemistry observation of BKVAN patients were performed by anti-SV40 large T antibody staining.
RESULTS AND CONCLUSION: Mycophenolic acid-AUC 0-12 and tacrolimus blood concentration in the BKVAN group were higher than those in the no BKVAN group (P < 0.05). SV-40 large T antigen staining of nine cases of biopsy showed that there were scattered positive tubular polyomaviruses in the renal cortex and medulla. Immunofluorescence staining showed the negative expression of IgG, IgM, IgA, C3, C4, C1q and C4d. All the renal histopathological observation showed that a large number of CD3, CD4 and CD8, CD68-positive cells were aggregated in the renal interstitial. In one case of merge rejection, human leukocyte antigen DR and interleukin-2 receptor were highly expressed. However, the expressions of human leukocyte antigen DR and interleukin-2 receptor in non-merge rejection patients were almost less than 5%. The follow-up of nine cases of BKVAN was more than 6 months, one case of renal allograft dysfunction, three cases improved, two cases of stable and three cases of deterioration. Immunohistochemistry with SV-40 large T antigen staining is used as an indirect method to document the presence of BKVAN. There is an extremely important clinical value of kidney allograft C4d, interleukin-2 receptor and human leukocyte antigen DR detection in the diagnosis of BKVAN.

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