array:25 [
  "pii" => "S2013251416300748"
  "issn" => "20132514"
  "doi" => "10.1016/j.nefroe.2016.08.005"
  "estado" => "S300"
  "fechaPublicacion" => "2016-09-01"
  "aid" => "186"
  "copyright" => "Sociedad Española de Nefrología"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "cor"
  "cita" => "Nefrologia (English Version). 2016;36:565-7"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3439
    "formatos" => array:3 [
      "EPUB" => 313
      "HTML" => 2469
      "PDF" => 657
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S0211699516300182"
      "issn" => "02116995"
      "doi" => "10.1016/j.nefro.2016.03.015"
      "estado" => "S300"
      "fechaPublicacion" => "2016-09-01"
      "aid" => "186"
      "copyright" => "Sociedad Española de Nefrología"
      "documento" => "simple-article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "cor"
      "cita" => "Nefrologia. 2016;36:565-7"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6405
        "formatos" => array:3 [
          "EPUB" => 418
          "HTML" => 4693
          "PDF" => 1294
        ]
      ]
      "en" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
        "titulo" => "BK virus nephropathy in a renal transplant patient&#58; Potential role of electron microscopy in diagnosis"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "565"
            "paginaFinal" => "567"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Nefropat&#237;a por virus BK en un paciente con trasplante renal&#58; Papel potencial de la microscop&#237;a electr&#243;nica en el diagn&#243;stico"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Fig&#46; 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1188
                "Ancho" => 1583
                "Tamanyo" => 318763
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Intranuclear inclusions in higher magnification&#46; Spherical viral particles with a diameter of 30<span class="elsevierStyleHsp" style=""></span>nm &#40;60&#44;000&#215;&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Simge Bardak, Kenan Turgutalp, Ebru Ball&#305;, Banu Co&#351;kun Y&#305;lmaz, &#304;clal G&#252;rses, Kaan Esen, Serap Demir, Ahmet K&#305;yk&#305;m"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "Simge"
                "apellidos" => "Bardak"
              ]
              1 => array:2 [
                "nombre" => "Kenan"
                "apellidos" => "Turgutalp"
              ]
              2 => array:2 [
                "nombre" => "Ebru"
                "apellidos" => "Ball&#305;"
              ]
              3 => array:2 [
                "nombre" => "Banu"
                "apellidos" => "Co&#351;kun Y&#305;lmaz"
              ]
              4 => array:2 [
                "nombre" => "&#304;clal"
                "apellidos" => "G&#252;rses"
              ]
              5 => array:2 [
                "nombre" => "Kaan"
                "apellidos" => "Esen"
              ]
              6 => array:2 [
                "nombre" => "Serap"
                "apellidos" => "Demir"
              ]
              7 => array:2 [
                "nombre" => "Ahmet"
                "apellidos" => "K&#305;yk&#305;m"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2013251416300748"
          "doi" => "10.1016/j.nefroe.2016.08.005"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251416300748?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516300182?idApp=UINPBA000064"
      "url" => "/02116995/0000003600000005/v3_201705130058/S0211699516300182/v3_201705130058/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2013251416301158"
    "issn" => "20132514"
    "doi" => "10.1016/j.nefroe.2016.11.009"
    "estado" => "S300"
    "fechaPublicacion" => "2016-09-01"
    "aid" => "202"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Nefrologia &#40;English Version&#41;. 2016;36:567-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4330
      "formatos" => array:3 [
        "EPUB" => 336
        "HTML" => 3217
        "PDF" => 777
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Risk factors associated with hernias on peritoneal dialysis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "567"
          "paginaFinal" => "568"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Factores de riesgo asociados a hernias en di&#225;lisis peritoneal"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ar&#225;nzazu Sastre, Jose Gonz&#225;lez-Arregoces, Igor Romainoik, Santiago Mari&#241;o, Cristina Lucas, Elena Monf&#225;, Ana Aguilera, Benjamin de Le&#243;n, George Stefan, Mario A&#46; Prieto"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Ar&#225;nzazu"
              "apellidos" => "Sastre"
            ]
            1 => array:2 [
              "nombre" => "Jose"
              "apellidos" => "Gonz&#225;lez-Arregoces"
            ]
            2 => array:2 [
              "nombre" => "Igor"
              "apellidos" => "Romainoik"
            ]
            3 => array:2 [
              "nombre" => "Santiago"
              "apellidos" => "Mari&#241;o"
            ]
            4 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Lucas"
            ]
            5 => array:2 [
              "nombre" => "Elena"
              "apellidos" => "Monf&#225;"
            ]
            6 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Aguilera"
            ]
            7 => array:2 [
              "nombre" => "Benjamin"
              "apellidos" => "de Le&#243;n"
            ]
            8 => array:2 [
              "nombre" => "George"
              "apellidos" => "Stefan"
            ]
            9 => array:2 [
              "nombre" => "Mario A&#46;"
              "apellidos" => "Prieto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0211699516300340"
        "doi" => "10.1016/j.nefro.2016.01.016"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516300340?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251416301158?idApp=UINPBA000064"
    "url" => "/20132514/0000003600000005/v1_201612260003/S2013251416301158/v1_201612260003/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2013251416301018"
    "issn" => "20132514"
    "doi" => "10.1016/j.nefroe.2016.11.004"
    "estado" => "S300"
    "fechaPublicacion" => "2016-09-01"
    "aid" => "187"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Nefrologia &#40;English Version&#41;. 2016;36:563-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4318
      "formatos" => array:3 [
        "EPUB" => 353
        "HTML" => 3371
        "PDF" => 594
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "When kidneys are no longer a friend&#58; An &#8220;out of the box&#8221; management for an unexpected evolution of an uncommon disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "563"
          "paginaFinal" => "565"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Cuando los ri&#241;ones dejan de ser un amigo&#58; Una gesti&#243;n &#8220;fuera de la caja&#8221; de una evoluci&#243;n imprevista de una enfermedad poco com&#250;n"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 626
              "Ancho" => 1700
              "Tamanyo" => 235792
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histological examination of the kidneys&#46; &#40;A&#41; Glomerular nodular deposits of amyloid stained with Congo red&#46; &#40;B&#41; Amyloid showing typical apple-green birefringence under polarized light&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Sandra Silva, Ricardo Pereira, Ivo Cunha, Carlos Ferreira, Ana Branco, Eduardo Eiras, Mrinalini Honavar, Joana Sim&#245;es, Teresa Santos, Teresa Chuva, Jos&#233; Costa"
          "autores" => array:11 [
            0 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Silva"
            ]
            1 => array:2 [
              "nombre" => "Ricardo"
              "apellidos" => "Pereira"
            ]
            2 => array:2 [
              "nombre" => "Ivo"
              "apellidos" => "Cunha"
            ]
            3 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Ferreira"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Branco"
            ]
            5 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Eiras"
            ]
            6 => array:2 [
              "nombre" => "Mrinalini"
              "apellidos" => "Honavar"
            ]
            7 => array:2 [
              "nombre" => "Joana"
              "apellidos" => "Sim&#245;es"
            ]
            8 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Santos"
            ]
            9 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Chuva"
            ]
            10 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Costa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251416301018?idApp=UINPBA000064"
    "url" => "/20132514/0000003600000005/v1_201612260003/S2013251416301018/v1_201612260003/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "BK virus nephropathy in a renal transplant patient&#58; Potential role of electron microscopy in diagnosis"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "565"
        "paginaFinal" => "567"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Simge Bardak, Kenan Turgutalp, Ebru Ball&#305;, Banu Co&#351;kun Y&#305;lmaz, &#304;clal G&#252;rses, Kaan Esen, Serap Demir, Ahmet K&#305;yk&#305;m"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "Simge"
            "apellidos" => "Bardak"
            "email" => array:1 [
              0 => "bardaksimge&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Kenan"
            "apellidos" => "Turgutalp"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Ebru"
            "apellidos" => "Ball&#305;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Banu"
            "apellidos" => "Co&#351;kun Y&#305;lmaz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "&#304;clal"
            "apellidos" => "G&#252;rses"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Kaan"
            "apellidos" => "Esen"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Serap"
            "apellidos" => "Demir"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Ahmet"
            "apellidos" => "K&#305;yk&#305;m"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Division of Nephrology&#44; Department of Internal Medicine&#44; School of Medicine&#44; Mersin University&#44; 33079 Mersin&#44; Turkey"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Histology and Embryology&#44; School of Medicine&#44; Mersin University&#44; Turkey"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Department of Pathology&#44; School of Medicine&#44; Mersin University&#44; Turkey"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Department of Radiology&#44; School of Medicine&#44; Mersin University&#44; Turkey"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Nefropat&#237;a por virus BK en un paciente con trasplante renal&#58; Papel potencial de la microscop&#237;a electr&#243;nica en el diagn&#243;stico"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1189
            "Ancho" => 1587
            "Tamanyo" => 295028
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tubular epithelial cell&#44; intranuclear inclusions &#40;10&#44;000&#215;&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">BK polyomavirus &#40;BKV&#41; causes latent&#44; asymptomatic infection in immunocompetent individuals&#46; In the setting of immunosuppression BKV can reactivate and lead to BK virus nephropathy &#40;BKVN&#41; in renal transplant recipients&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> BKVN is one of the main causes of allograft failure in renal transplant patients&#46; Acute rejection and different viral infections should be considered in differential diagnosis of renal allograft dysfunction&#46; Electron microscopy &#40;EM&#41; could help to distinguish BKV from other viral factors in allograft tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Herein&#44; we described inclusions due to BKV seen by EM in a renal transplant biopsy and we discussed potential role of EM in diagnosis of BKVN&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 49 years old woman had renal transplantation from non-relative donor 2 years ago&#46; Although she was asymptomatic&#44; her serum creatinine level was increased gradually during last 3&#8211;4 months &#40;from 1&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl to 1&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46; Her primary renal disease was unknown&#46; She had been under the treatment of tacrolimus 2<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mg&#44; prednisolone 5<span class="elsevierStyleHsp" style=""></span>mg&#44; mycophenolate sodium 3<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>360<span class="elsevierStyleHsp" style=""></span>mg&#46; Physical examination was normal&#46; Serum creatinine was 1&#46;82<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; urine microscopy was normal&#46; 154<span class="elsevierStyleHsp" style=""></span>mg&#47;day proteinuria was obtained&#46; ANA was positive&#44; though ENA was negative&#46; Anti CMV IgM was negative&#44; whereas serum BK&#47;JC PCR was positive&#46; Serum tacrolimus level was 9&#46;5<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; Transplant renal doppler ultrasonography revealed normal findings&#46; Renal biopsy was performed&#46; Intranuclear inclusions&#44; cytoplasmic and nuclear enlargement in tubular epithelial cells and tubular necrosis were seen on light microscopy&#46; These biopsy findings might suggest viral infection of the renal allograft&#46; Immunohistochemical analysis of the renal biopsy for CMV was negative&#44; but study with SV40 antigen could not be performed as it was not available in our center&#46; Intranuclear spherical viral particles were seen in some tubular epithelial cells on EM &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Viral particles were in paracrystalline structure and about 30<span class="elsevierStyleHsp" style=""></span>nm in diameter&#46; They were differentiated from inclusions of adenovirus with 80&#8211;100<span class="elsevierStyleHsp" style=""></span>nm in diameter &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Finally&#44; BKVN was diagnosed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">BKVN is one of the well-known reasons of morbidity in renal transplant patients&#46; It occurs with a prevalence of 1&#8211;10&#37; in renal transplant patients and graft loss is up to 80&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> BKVN occurs mostly during the first year after transplantation and it is characterized only by deterioration of renal functions&#44; usually without any symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Early diagnosis is important to prevent allograft dysfunction in kidney transplant patients&#46; Our patient was also declared no symptoms&#44; but only a gradual increase in serum creatinine was observed in the second year of follow up&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The pathogenesis of BKVN is characterized by high grade BKV replication in renal-tubular epithelial cells of renal allograft&#46; Necrosis of tubular cells let BKV leak into the tissue and blood&#44; and then inflammatory cell infiltration to interstitium occurs&#46; This leads to tubular atrophy&#44; interstitial fibrosis and therefore impaired graft function&#46; Intensive immunosuppressive therapy is the leading risk factor in the development of BKVN&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Plasma and urine polymerase chain reaction &#40;PCR&#41;&#44; urine cytology&#44; and urine electron microscopy &#40;EM&#41; can be performed in diagnosis of BKVN whereas renal biopsy is the gold standard method&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;5</span></a> Multiple biopsy should be performed because of multi-focal involvement to prevent sampling errors and biopsy specimen should contain medullary parenchyma as the virus is more likely to present in the medulla&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Intranuclear inclusions&#44; lysis or necrosis of tubular cells showing tubulointerstitial inflammation could be observed on light microscopy&#46; However&#44; changes observed during light microscopy are not pathognomonic for BKVN&#46; Immunohistochemistry &#40;SV40 staining&#41; and EM should be performed&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Herpes simplex virus&#44; adenovirus&#44; CMV&#44; Epstein&#8211;Barr virus &#40;EBV&#41; should also be considered in differential diagnosis as they may cause similar histologic findings&#46; Immunohistochemistry and EM can be helpful in differential diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> Viral particles of BKV are characteristically 30&#8211;50<span class="elsevierStyleHsp" style=""></span>nm in diameter and occasionally form crystalloid structures&#44; whereas inclusions due to family of herpesviridae &#40;including Herpes simplex&#44; EBV and CMV&#41; and adenoviruses are bigger in size &#40;120&#8211;150<span class="elsevierStyleHsp" style=""></span>nm and 70&#8211;90<span class="elsevierStyleHsp" style=""></span>nm respectively&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;6&#44;9&#44;10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our patient&#44; size of the viral particles was 30<span class="elsevierStyleHsp" style=""></span>nm in average&#46; Although light microscopic detection of intranuclear inclusions suggested viral infection of renal allograft&#44; it was the EM that defined dimensions of inclusions and helped the diagnosis&#46; In conclusion&#44; EM evaluation of allograft biopsy may be important in the differential diagnosis of different viral infections of allograft&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1189
            "Ancho" => 1587
            "Tamanyo" => 295028
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tubular epithelial cell&#44; intranuclear inclusions &#40;10&#44;000&#215;&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1188
            "Ancho" => 1583
            "Tamanyo" => 338630
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Intranuclear inclusions in higher magnification&#46; Spherical viral particles with a diameter of 30<span class="elsevierStyleHsp" style=""></span>nm &#40;60&#44;000&#215;&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "BK virus infection in transplant recipients&#58; clinical manifestations&#44; treatment options and the immune response"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;C&#46; van Aalderen"
                            1 => "K&#46;M&#46; Heutinck"
                            2 => "C&#46; Huisman"
                            3 => "I&#46;J&#46; ten Berge"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Neth J Med"
                        "fecha" => "2012"
                        "volumen" => "70"
                        "numero" => "4"
                        "paginaInicial" => "172"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22641625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "BK-virus nephropathy in renal transplants-tubular necrosis&#44; MHC-class II expression and rejection in a puzzling game"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "V&#46; Nickeleit"
                            1 => "H&#46;H&#46; Hirsch"
                            2 => "M&#46; Zeiler"
                            3 => "F&#46; Gudat"
                            4 => "O&#46; Prince"
                            5 => "G&#46; Thiel"
                            6 => "M&#46;J&#46; Mihatsch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2000"
                        "volumen" => "15"
                        "paginaInicial" => "324"
                        "paginaFinal" => "332"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10692517"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "BK polyomavirus in solid organ transplantation"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "the AST Infectious Diseases Community of Practice"
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;H&#46; Hirscha"
                            1 => "P&#46; Randhawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ajt.12110"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Transplant"
                        "fecha" => "2013"
                        "volumen" => "13"
                        "paginaInicial" => "179"
                        "paginaFinal" => "188"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23465010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "BK virus infection&#58; an update on diagnosis and treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Sawinski"
                            1 => "S&#46; Goral"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfu023"
                      "Revista" => array:7 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2015"
                        "volumen" => "30"
                        "numero" => "2"
                        "paginaInicial" => "209"
                        "paginaFinal" => "217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24574543"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Polyomavirus infection of renal allograft recipients&#58; from latent infection to manifest disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Nickeleit"
                            1 => "H&#46;H&#46; Hirsch"
                            2 => "I&#46;F&#46; Binet"
                            3 => "F&#46; Gudat"
                            4 => "O&#46; Prince"
                            5 => "P&#46; Dalquen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Nephrol"
                        "fecha" => "1999"
                        "volumen" => "10"
                        "paginaInicial" => "1080"
                        "paginaFinal" => "1089"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10232695"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "pp&#46; 661 and 891"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal glomerular disease and infectious agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46;R&#46; Dickersin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2nd ed&#46;"
                        "titulo" => "Diagnostic electron microscopy"
                        "fecha" => "2000"
                        "editorial" => "Springer"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "BK polyomavirus in renal transplants&#58; role of electron microscopy and immunostaining in detecting early infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "S&#46; Latif"
                            1 => "F&#46; Zaman"
                            2 => "R&#46; Veeramachaneni"
                            3 => "L&#46; Jones"
                            4 => "N&#46; Uribe-Uribe"
                            5 => "E&#46;A&#46; Turbat-Herrera"
                            6 => "G&#46;A&#46; Herrera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/01913120701376113"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ultrastruct Pathol"
                        "fecha" => "2007"
                        "volumen" => "31"
                        "numero" => "3"
                        "paginaInicial" => "199"
                        "paginaFinal" => "207"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17613999"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primer&#58; histopathology of polyomavirus-associated nephropathy in renal allografts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Liptak"
                            1 => "E&#46; Kemeny"
                            2 => "B&#46; Ivanyi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ncpneph0319"
                      "Revista" => array:7 [
                        "tituloSerie" => "Nat Clin Pract Nephrol"
                        "fecha" => "2006"
                        "volumen" => "2"
                        "numero" => "11"
                        "paginaInicial" => "631"
                        "paginaFinal" => "636"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17066055"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Polyomavirus-associated nephropathy in renal transplantation&#58; interdisciplinary analyses and recommendations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;H&#46; Hirsch"
                            1 => "D&#46;C&#46; Brennan"
                            2 => "C&#46;B&#46; Drachenberg"
                            3 => "F&#46; Ginevri"
                            4 => "J&#46; Gordon"
                            5 => "A&#46;P&#46; Limaye"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Transplantation"
                        "fecha" => "2005"
                        "volumen" => "79"
                        "numero" => "10"
                        "paginaInicial" => "1277"
                        "paginaFinal" => "1286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15912088"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cytopathology in viral diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "N&#46;F&#46; Cheville"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:5 [
                        "edicion" => "1st ed&#46;"
                        "titulo" => "Ultrastructural pathology&#58; an introduction to interpretation"
                        "fecha" => "1994"
                        "paginaInicial" => "502"
                        "editorial" => "Iowa State University Press"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003600000005/v1_201612260003/S2013251416300748/v1_201612260003/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35436"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003600000005/v1_201612260003/S2013251416300748/v1_201612260003/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251416300748?idApp=UINPBA000064"
]
Share
Journal Information
Vol. 36. Issue. 5.September - October 2016
Pages 465-582
Share
Share
Download PDF
More article options
Vol. 36. Issue. 5.September - October 2016
Pages 465-582
Letter to the Editor
Open Access
BK virus nephropathy in a renal transplant patient: Potential role of electron microscopy in diagnosis
Nefropatía por virus BK en un paciente con trasplante renal: Papel potencial de la microscopía electrónica en el diagnóstico
Visits
8048
Simge Bardaka,
Corresponding author
bardaksimge@gmail.com

Corresponding author.
, Kenan Turgutalpa, Ebru Ballıb, Banu Coşkun Yılmazb, İclal Gürsesc, Kaan Esend, Serap Demira, Ahmet Kıykıma
a Division of Nephrology, Department of Internal Medicine, School of Medicine, Mersin University, 33079 Mersin, Turkey
b Department of Histology and Embryology, School of Medicine, Mersin University, Turkey
c Department of Pathology, School of Medicine, Mersin University, Turkey
d Department of Radiology, School of Medicine, Mersin University, Turkey
This item has received

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (2)
Full Text
Dear Editor,

BK polyomavirus (BKV) causes latent, asymptomatic infection in immunocompetent individuals. In the setting of immunosuppression BKV can reactivate and lead to BK virus nephropathy (BKVN) in renal transplant recipients.1 BKVN is one of the main causes of allograft failure in renal transplant patients. Acute rejection and different viral infections should be considered in differential diagnosis of renal allograft dysfunction. Electron microscopy (EM) could help to distinguish BKV from other viral factors in allograft tissue.2 Herein, we described inclusions due to BKV seen by EM in a renal transplant biopsy and we discussed potential role of EM in diagnosis of BKVN.

A 49 years old woman had renal transplantation from non-relative donor 2 years ago. Although she was asymptomatic, her serum creatinine level was increased gradually during last 3–4 months (from 1.2mg/dl to 1.7mg/dl). Her primary renal disease was unknown. She had been under the treatment of tacrolimus 2+1mg, prednisolone 5mg, mycophenolate sodium 3×360mg. Physical examination was normal. Serum creatinine was 1.82mg/dl, urine microscopy was normal. 154mg/day proteinuria was obtained. ANA was positive, though ENA was negative. Anti CMV IgM was negative, whereas serum BK/JC PCR was positive. Serum tacrolimus level was 9.5ng/ml. Transplant renal doppler ultrasonography revealed normal findings. Renal biopsy was performed. Intranuclear inclusions, cytoplasmic and nuclear enlargement in tubular epithelial cells and tubular necrosis were seen on light microscopy. These biopsy findings might suggest viral infection of the renal allograft. Immunohistochemical analysis of the renal biopsy for CMV was negative, but study with SV40 antigen could not be performed as it was not available in our center. Intranuclear spherical viral particles were seen in some tubular epithelial cells on EM (Fig. 1). Viral particles were in paracrystalline structure and about 30nm in diameter. They were differentiated from inclusions of adenovirus with 80–100nm in diameter (Fig. 2). Finally, BKVN was diagnosed.

Fig. 1.

Tubular epithelial cell, intranuclear inclusions (10,000×).

(0.28MB).
Fig. 2.

Intranuclear inclusions in higher magnification. Spherical viral particles with a diameter of 30nm (60,000×).

(0.32MB).

BKVN is one of the well-known reasons of morbidity in renal transplant patients. It occurs with a prevalence of 1–10% in renal transplant patients and graft loss is up to 80%.3,4 BKVN occurs mostly during the first year after transplantation and it is characterized only by deterioration of renal functions, usually without any symptoms.1 Early diagnosis is important to prevent allograft dysfunction in kidney transplant patients. Our patient was also declared no symptoms, but only a gradual increase in serum creatinine was observed in the second year of follow up.

The pathogenesis of BKVN is characterized by high grade BKV replication in renal-tubular epithelial cells of renal allograft. Necrosis of tubular cells let BKV leak into the tissue and blood, and then inflammatory cell infiltration to interstitium occurs. This leads to tubular atrophy, interstitial fibrosis and therefore impaired graft function. Intensive immunosuppressive therapy is the leading risk factor in the development of BKVN.4

Plasma and urine polymerase chain reaction (PCR), urine cytology, and urine electron microscopy (EM) can be performed in diagnosis of BKVN whereas renal biopsy is the gold standard method.3,5 Multiple biopsy should be performed because of multi-focal involvement to prevent sampling errors and biopsy specimen should contain medullary parenchyma as the virus is more likely to present in the medulla.5 Intranuclear inclusions, lysis or necrosis of tubular cells showing tubulointerstitial inflammation could be observed on light microscopy. However, changes observed during light microscopy are not pathognomonic for BKVN. Immunohistochemistry (SV40 staining) and EM should be performed.6

Herpes simplex virus, adenovirus, CMV, Epstein–Barr virus (EBV) should also be considered in differential diagnosis as they may cause similar histologic findings. Immunohistochemistry and EM can be helpful in differential diagnosis.6–8 Viral particles of BKV are characteristically 30–50nm in diameter and occasionally form crystalloid structures, whereas inclusions due to family of herpesviridae (including Herpes simplex, EBV and CMV) and adenoviruses are bigger in size (120–150nm and 70–90nm respectively).2,6,9,10

In our patient, size of the viral particles was 30nm in average. Although light microscopic detection of intranuclear inclusions suggested viral infection of renal allograft, it was the EM that defined dimensions of inclusions and helped the diagnosis. In conclusion, EM evaluation of allograft biopsy may be important in the differential diagnosis of different viral infections of allograft.

Conflicts of interest

The authors declare that they have no conflicts of interest related to the contents of this article.

References
[1]
M.C. van Aalderen, K.M. Heutinck, C. Huisman, I.J. ten Berge.
BK virus infection in transplant recipients: clinical manifestations, treatment options and the immune response.
Neth J Med, 70 (2012), pp. 172-183
[2]
V. Nickeleit, H.H. Hirsch, M. Zeiler, F. Gudat, O. Prince, G. Thiel, M.J. Mihatsch.
BK-virus nephropathy in renal transplants-tubular necrosis, MHC-class II expression and rejection in a puzzling game.
Nephrol Dial Transplant, 15 (2000), pp. 324-332
[3]
H.H. Hirscha, P. Randhawa, the AST Infectious Diseases Community of Practice.
BK polyomavirus in solid organ transplantation.
Am J Transplant, 13 (2013), pp. 179-188
[4]
D. Sawinski, S. Goral.
BK virus infection: an update on diagnosis and treatment.
Nephrol Dial Transplant, 30 (2015), pp. 209-217
[5]
V. Nickeleit, H.H. Hirsch, I.F. Binet, F. Gudat, O. Prince, P. Dalquen, et al.
Polyomavirus infection of renal allograft recipients: from latent infection to manifest disease.
J Am Soc Nephrol, 10 (1999), pp. 1080-1089
[6]
G.R. Dickersin.
Renal glomerular disease and infectious agents.
Diagnostic electron microscopy, 2nd ed., Springer, (2000),
pp. 661 and 891
[7]
S. Latif, F. Zaman, R. Veeramachaneni, L. Jones, N. Uribe-Uribe, E.A. Turbat-Herrera, G.A. Herrera.
BK polyomavirus in renal transplants: role of electron microscopy and immunostaining in detecting early infection.
Ultrastruct Pathol, 31 (2007), pp. 199-207
[8]
P. Liptak, E. Kemeny, B. Ivanyi.
Primer: histopathology of polyomavirus-associated nephropathy in renal allografts.
Nat Clin Pract Nephrol, 2 (2006), pp. 631-636
[9]
H.H. Hirsch, D.C. Brennan, C.B. Drachenberg, F. Ginevri, J. Gordon, A.P. Limaye, et al.
Polyomavirus-associated nephropathy in renal transplantation: interdisciplinary analyses and recommendations.
Transplantation, 79 (2005), pp. 1277-1286
[10]
N.F. Cheville.
Cytopathology in viral diseases.
Ultrastructural pathology: an introduction to interpretation, 1st ed., Iowa State University Press, (1994), pp. 502
Copyright © 2016. Sociedad Española de Nefrología
Download PDF
Idiomas
Nefrología (English Edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?