Letter to the Editor
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
Simge Bardaka,
, Kenan Turgutalpa, Ebru Ballıb, Banu Coşkun Yılmazb, İclal Gürsesc, Kaan Esend, Serap Demira, Ahmet Kıykıma
Corresponding author
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
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"referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</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" => "Ballı" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Banu" "apellidos" => "Coşkun Yılmaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "İclal" "apellidos" => "Gürses" "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" => "Kıykım" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Division of Nephrology, Department of Internal Medicine, School of Medicine, Mersin University, 33079 Mersin, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Histology and Embryology, School of Medicine, Mersin University, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Pathology, School of Medicine, Mersin University, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Radiology, School of Medicine, Mersin University, Turkey" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nefropatía por virus BK en un paciente con trasplante renal: Papel potencial de la microscopía electrónica en el diagnóstico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 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, intranuclear inclusions (10,000×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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.<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. 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.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> 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.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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 1.2<span class="elsevierStyleHsp" style=""></span>mg/dl to 1.7<span class="elsevierStyleHsp" style=""></span>mg/dl). Her primary renal disease was unknown. She had been under the treatment of tacrolimus 2<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mg, prednisolone 5<span class="elsevierStyleHsp" style=""></span>mg, mycophenolate sodium 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>360<span class="elsevierStyleHsp" style=""></span>mg. Physical examination was normal. Serum creatinine was 1.82<span class="elsevierStyleHsp" style=""></span>mg/dl, urine microscopy was normal. 154<span class="elsevierStyleHsp" style=""></span>mg/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 9.5<span class="elsevierStyleHsp" style=""></span>ng/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 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Viral particles were in paracrystalline structure and about 30<span class="elsevierStyleHsp" style=""></span>nm in diameter. They were differentiated from inclusions of adenovirus with 80–100<span class="elsevierStyleHsp" style=""></span>nm in diameter (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Finally, BKVN was diagnosed.</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. It occurs with a prevalence of 1–10% in renal transplant patients and graft loss is up to 80%.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> BKVN occurs mostly during the first year after transplantation and it is characterized only by deterioration of renal functions, usually without any symptoms.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> 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.</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. 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.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,5</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.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–8</span></a> Viral particles of BKV are characteristically 30–50<span class="elsevierStyleHsp" style=""></span>nm 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 (120–150<span class="elsevierStyleHsp" style=""></span>nm and 70–90<span class="elsevierStyleHsp" style=""></span>nm respectively).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,6,9,10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our patient, size of the viral particles was 30<span class="elsevierStyleHsp" style=""></span>nm 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.</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.</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. 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, intranuclear inclusions (10,000×).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 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. Spherical viral particles with a diameter of 30<span class="elsevierStyleHsp" style=""></span>nm (60,000×).</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: clinical manifestations, treatment options and the immune response" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.C. van Aalderen" 1 => "K.M. Heutinck" 2 => "C. Huisman" 3 => "I.J. 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, MHC-class II expression and rejection in a puzzling game" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "V. Nickeleit" 1 => "H.H. Hirsch" 2 => "M. Zeiler" 3 => "F. Gudat" 4 => "O. Prince" 5 => "G. Thiel" 6 => "M.J. 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.H. Hirscha" 1 => "P. 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: an update on diagnosis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Sawinski" 1 => "S. 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: from latent infection to manifest disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Nickeleit" 1 => "H.H. Hirsch" 2 => "I.F. Binet" 3 => "F. Gudat" 4 => "O. Prince" 5 => "P. 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. 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.R. Dickersin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "2nd ed." "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: role of electron microscopy and immunostaining in detecting early infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "S. Latif" 1 => "F. Zaman" 2 => "R. Veeramachaneni" 3 => "L. Jones" 4 => "N. Uribe-Uribe" 5 => "E.A. Turbat-Herrera" 6 => "G.A. 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: histopathology of polyomavirus-associated nephropathy in renal allografts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Liptak" 1 => "E. Kemeny" 2 => "B. 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: interdisciplinary analyses and recommendations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.H. Hirsch" 1 => "D.C. Brennan" 2 => "C.B. Drachenberg" 3 => "F. Ginevri" 4 => "J. Gordon" 5 => "A.P. 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.F. Cheville" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "edicion" => "1st ed." "titulo" => "Ultrastructural pathology: 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" ]
| Year/Month | Html | Total | |
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| 2024 November | 2 | 1 | 3 |
| 2024 October | 51 | 39 | 90 |
| 2024 September | 51 | 38 | 89 |
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| 2024 July | 48 | 23 | 71 |
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| 2024 May | 59 | 32 | 91 |
| 2024 April | 62 | 31 | 93 |
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| 2024 January | 43 | 28 | 71 |
| 2023 December | 26 | 21 | 47 |
| 2023 November | 38 | 25 | 63 |
| 2023 October | 36 | 35 | 71 |
| 2023 September | 32 | 29 | 61 |
| 2023 August | 45 | 21 | 66 |
| 2023 July | 41 | 22 | 63 |
| 2023 June | 42 | 24 | 66 |
| 2023 May | 50 | 32 | 82 |
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| 2023 March | 44 | 25 | 69 |
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| 2022 December | 92 | 36 | 128 |
| 2022 November | 59 | 26 | 85 |
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| 2022 September | 43 | 23 | 66 |
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| 2022 May | 88 | 32 | 120 |
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| 2021 September | 53 | 37 | 90 |
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| 2021 June | 43 | 24 | 67 |
| 2021 May | 70 | 40 | 110 |
| 2021 April | 127 | 73 | 200 |
| 2021 March | 175 | 32 | 207 |
| 2021 February | 130 | 26 | 156 |
| 2021 January | 90 | 31 | 121 |
| 2020 December | 82 | 16 | 98 |
| 2020 November | 57 | 17 | 74 |
| 2020 October | 47 | 19 | 66 |
| 2020 September | 43 | 22 | 65 |
| 2020 August | 58 | 13 | 71 |
| 2020 July | 50 | 18 | 68 |
| 2020 June | 67 | 16 | 83 |
| 2020 May | 53 | 13 | 66 |
| 2020 April | 51 | 20 | 71 |
| 2020 March | 62 | 16 | 78 |
| 2020 February | 49 | 18 | 67 |
| 2020 January | 77 | 30 | 107 |
| 2019 December | 69 | 34 | 103 |
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| 2019 April | 90 | 48 | 138 |
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| 2018 September | 95 | 16 | 111 |
| 2018 August | 51 | 22 | 73 |
| 2018 July | 55 | 12 | 67 |
| 2018 June | 56 | 9 | 65 |
| 2018 May | 69 | 21 | 90 |
| 2018 April | 70 | 8 | 78 |
| 2018 March | 88 | 5 | 93 |
| 2018 February | 94 | 7 | 101 |
| 2018 January | 60 | 4 | 64 |
| 2017 December | 87 | 5 | 92 |
| 2017 November | 53 | 11 | 64 |
| 2017 October | 34 | 7 | 41 |
| 2017 September | 46 | 15 | 61 |
| 2017 August | 25 | 11 | 36 |
| 2017 July | 35 | 18 | 53 |
| 2017 June | 35 | 10 | 45 |
| 2017 May | 40 | 14 | 54 |
| 2017 April | 53 | 8 | 61 |
| 2017 March | 26 | 24 | 50 |
| 2017 February | 33 | 8 | 41 |
| 2017 January | 47 | 14 | 61 |
| 2016 December | 2 | 0 | 2 |
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