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Perrando, Resistencia, Chaco, Argentina, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Unidad de Ablación e Implante Renal, Hospital Dr. Julio C. Perrando, Resistencia, Chaco, Argentina, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12657_19904_60062_es_12657_t1.jpg" "Alto" => 264 "Ancho" => 576 "Tamanyo" => 105368 ] ] "descripcion" => array:1 [ "en" => "Nº Miss Match, Viruria, Viremia, Función Renal y Biopsia en pacientes con infección activa por el Virus BK" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor,</span></p><p class="elsevierStylePara">BK virus (BKV) has a high prevalence in the world population (> 80%). Although it does not cause disease in immunocompetent patients, it remains latent in the kidneys and urinary tract<span class="elsevierStyleSup">1</span>.</p><p class="elsevierStylePara">Its reactivation in renal transplant recipients can lead to BKV-associated nephropathy (BKVAN). There is no specific treatment and the therapeutic strategy consists on the change of immunosuppressive drugs or dose adjustment. The correct detection and monitoring of this virus is crucial, since early intervention could prevent development of disease<span class="elsevierStyleSup">2</span>.</p><p class="elsevierStylePara">Active viral infection may be confused or coexist with cellular rejection, but they are two opposing entities, so it is essential to differentiate them.</p><p class="elsevierStylePara">Renal biopsy is the gold standard for BKVAN diagnosis<span class="elsevierStyleSup">2,3</span>. However, real time PCR (polymerase chain reaction) makes it possible to quantify viral load and detect patients at risk for nephropathy before tissue damage occurs<span class="elsevierStyleSup">4,5</span>.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objective: </span>To analyse the incidence of active BKV infection and the development of BKVAN in patients during their first two years after renal transplantation.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">We studied 70 kidney recipients in the Renal Transplant Unit of Dr. Julio C. Perrando Hospital; 62 of them received kidneys from cadaveric donors. Urine samples were included for BKV screening in patients who were in their first two years post-transplantation (viruria was monitored every three months during the first two years; if levels of viruria >10<span class="elsevierStyleSup">7</span> copies/mL, plasma detection was performed).</p><p class="elsevierStylePara">Patients received induction with daclizumab/baxilzumab-methylprednisolone-mycophenolate-mofetil (MMF) and maintenance with tacrolimus-MMF-steroids.</p><p class="elsevierStylePara">DNAs were extracted using commercial columns (Quick-gDNA MiniPrep, Zymo Research, U.S.A.).</p><p class="elsevierStylePara">Qualitative real-time PCR was performed, using primers according to Randhawa et al<span class="elsevierStyleSup">5</span>. Positive samples were quantified by commercial Q-PCR Alert (Nanogen Advanced Diagnostics SRL<span class="elsevierStyleSup">®</span>).</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">Viruria was detected >10<span class="elsevierStyleSup">7</span> copies/mL in 12 of the 70 patients (17%), but only 5 had persistent viruria, the others were transient.</p><p class="elsevierStylePara">Active infection was between 3 and 24 months after transplantation, with positive viraemia after 12 months.</p><p class="elsevierStylePara">Half of patients with viruria also suffered from renal function deterioration (creatinine > 1.4mg/dL).</p><p class="elsevierStylePara">Table 1 shows the number of missmatch, renal function, biopsy, viruria and viraemia in patients with persistent levels of viruria.</p><p class="elsevierStylePara">BKVAN was confirmed by biopsy in 1 patient, and therefore had an incidence of 1.4% in our centre.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case report</span></p><p class="elsevierStylePara">55 year-old patient who received a cadaveric transplant. Induction: daclizumab-tacrolimus-MMF-steroids. Maintenance: tacrolimus-MMF-steroids. Creatinine 1mg/dL and 1.2mg/dL; creatinine clearance: 96mL, no proteinuria. Nine months after transplantation, the patient presented viruria (10<span class="elsevierStyleSup">7</span> copies/mL) for BKV without renal dysfunction and with negative viraemia. High levels of viruria persisted with negative viraemia, which became positive at month 12 (> 10<span class="elsevierStyleSup">4 </span>copies/mL); biopsy findings: interstitial nephritis, tubular nuclear alterations related to BKV. The immunosupressive treatment was switched to sirolimus 2mg/day and ciprofloxacin 500mg/day (10 days) is added. The patient maintained stable renal function values, clearance 86mL, without proteinuria and decreased viral load in blood and urine. Currently, the patient has still his kidney and does not require dialysis.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">The prevalence of BKV in the urine of renal transplant patients ranges from 18%-40%: Shenagari et al.<span class="elsevierStyleSup">6</span> report 40%, Costa et al. 18,3%<span class="elsevierStyleSup">7</span> and Viscount et al. 24%<span class="elsevierStyleSup">4</span>. Reactivation usually occurs within the first two months post-transplant<span class="elsevierStyleSup">8</span>. In our study, we determined viral load in plasma in the 5 patients with persistent viruria, 2 had viral loads> 10<span class="elsevierStyleSup">4</span> copies/mL, similar to other reports, in one patient BKVAN was found by biopsy, and the other patient had a non-conclusive biopsy. BKVAN lesions are multifocal with random distribution, and can give false negatives<span class="elsevierStyleSup">3</span>.</p><p class="elsevierStylePara">Hirsch et al.<span class="elsevierStyleSup">9</span> monitored BKV replication during the first year after transplant, and found the highest values of viruria and viraemia (25.4% and 13.7%, respectively) 6 months after transplantation.</p><p class="elsevierStylePara">Babel et al.<span class="elsevierStyleSup">10</span> showed that 21.4% of patients with persistent viruria developed BKVAN between 5 and 11 weeks after reactivation in urine and blood. In our patient with BKVAN, viruria appeared 12 weeks before viraemia and this became positive almost simultaneously with biopsy findings, without clinical signs of renal dysfunction (no protocol biopsies performed in the centre).</p><p class="elsevierStylePara">In addition to immunosuppression, other factors such as inflammation and host immunity should be considered in the pathogenesis of BKVAN.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara">The positivity of PCR in urine may be the first finding indicative of BKV reactivation. In our patient, screening determined a significant and persistent viral load in urine 12 weeks before viraemia, which could be an advantage for early detection of reactivation and allow adjustment of immunosuppression, although viraemia is more strongly associated with the development nephropathy. The data reported are useful, since so far no literature has been published on the incidence of BKV reactivation in renal transplantation in Argentina.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/12657_19904_60062_es_12657_t1.jpg" class="elsevierStyleCrossRefs"><img src="12657_19904_60062_es_12657_t1.jpg" alt="Nº Miss Match, Viruria, Viremia, Función Renal y Biopsia en pacientes con infección activa por el Virus BK"></img></a></p><p class="elsevierStylePara">Tabla 1. 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año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 6 | 1 | 7 |
2024 Octubre | 54 | 33 | 87 |
2024 Septiembre | 60 | 27 | 87 |
2024 Agosto | 69 | 59 | 128 |
2024 Julio | 65 | 31 | 96 |
2024 Junio | 89 | 48 | 137 |
2024 Mayo | 71 | 30 | 101 |
2024 Abril | 62 | 41 | 103 |
2024 Marzo | 52 | 21 | 73 |
2024 Febrero | 42 | 35 | 77 |
2024 Enero | 50 | 30 | 80 |
2023 Diciembre | 36 | 30 | 66 |
2023 Noviembre | 40 | 40 | 80 |
2023 Octubre | 34 | 32 | 66 |
2023 Septiembre | 29 | 22 | 51 |
2023 Agosto | 33 | 17 | 50 |
2023 Julio | 42 | 22 | 64 |
2023 Junio | 51 | 29 | 80 |
2023 Mayo | 40 | 38 | 78 |
2023 Abril | 48 | 18 | 66 |
2023 Marzo | 28 | 30 | 58 |
2023 Febrero | 44 | 32 | 76 |
2023 Enero | 48 | 29 | 77 |
2022 Diciembre | 64 | 35 | 99 |
2022 Noviembre | 48 | 35 | 83 |
2022 Octubre | 63 | 43 | 106 |
2022 Septiembre | 59 | 44 | 103 |
2022 Agosto | 85 | 43 | 128 |
2022 Julio | 73 | 50 | 123 |
2022 Junio | 59 | 44 | 103 |
2022 Mayo | 68 | 44 | 112 |
2022 Abril | 51 | 58 | 109 |
2022 Marzo | 57 | 47 | 104 |
2022 Febrero | 44 | 50 | 94 |
2022 Enero | 60 | 48 | 108 |
2021 Diciembre | 41 | 45 | 86 |
2021 Noviembre | 58 | 48 | 106 |
2021 Octubre | 65 | 52 | 117 |
2021 Septiembre | 55 | 51 | 106 |
2021 Agosto | 59 | 47 | 106 |
2021 Julio | 44 | 37 | 81 |
2021 Junio | 32 | 26 | 58 |
2021 Mayo | 37 | 47 | 84 |
2021 Abril | 70 | 72 | 142 |
2021 Marzo | 61 | 48 | 109 |
2021 Febrero | 51 | 23 | 74 |
2021 Enero | 51 | 35 | 86 |
2020 Diciembre | 42 | 29 | 71 |
2020 Noviembre | 39 | 30 | 69 |
2020 Octubre | 26 | 29 | 55 |
2020 Septiembre | 38 | 18 | 56 |
2020 Agosto | 43 | 15 | 58 |
2020 Julio | 30 | 27 | 57 |
2020 Junio | 36 | 28 | 64 |
2020 Mayo | 43 | 19 | 62 |
2020 Abril | 24 | 26 | 50 |
2020 Marzo | 36 | 30 | 66 |
2020 Febrero | 36 | 34 | 70 |
2020 Enero | 43 | 39 | 82 |
2019 Diciembre | 41 | 31 | 72 |
2019 Noviembre | 32 | 22 | 54 |
2019 Octubre | 22 | 13 | 35 |
2019 Septiembre | 31 | 14 | 45 |
2019 Agosto | 23 | 27 | 50 |
2019 Julio | 29 | 23 | 52 |
2019 Junio | 38 | 22 | 60 |
2019 Mayo | 39 | 33 | 72 |
2019 Abril | 77 | 50 | 127 |
2019 Marzo | 35 | 19 | 54 |
2019 Febrero | 30 | 14 | 44 |
2019 Enero | 26 | 22 | 48 |
2018 Diciembre | 80 | 49 | 129 |
2018 Noviembre | 116 | 17 | 133 |
2018 Octubre | 75 | 18 | 93 |
2018 Septiembre | 75 | 8 | 83 |
2018 Agosto | 53 | 14 | 67 |
2018 Julio | 48 | 14 | 62 |
2018 Junio | 55 | 11 | 66 |
2018 Mayo | 50 | 17 | 67 |
2018 Abril | 70 | 15 | 85 |
2018 Marzo | 33 | 12 | 45 |
2018 Febrero | 39 | 10 | 49 |
2018 Enero | 49 | 6 | 55 |
2017 Diciembre | 42 | 6 | 48 |
2017 Noviembre | 56 | 13 | 69 |
2017 Octubre | 39 | 10 | 49 |
2017 Septiembre | 60 | 9 | 69 |
2017 Agosto | 73 | 7 | 80 |
2017 Julio | 78 | 21 | 99 |
2017 Junio | 57 | 16 | 73 |
2017 Mayo | 65 | 16 | 81 |
2017 Abril | 72 | 14 | 86 |
2017 Marzo | 47 | 9 | 56 |
2017 Febrero | 35 | 5 | 40 |
2017 Enero | 19 | 8 | 27 |
2016 Diciembre | 54 | 8 | 62 |
2016 Noviembre | 102 | 12 | 114 |
2016 Octubre | 147 | 33 | 180 |
2016 Septiembre | 156 | 2 | 158 |
2016 Agosto | 236 | 8 | 244 |
2016 Julio | 223 | 8 | 231 |
2016 Junio | 133 | 0 | 133 |
2016 Mayo | 161 | 0 | 161 |
2016 Abril | 142 | 0 | 142 |
2016 Marzo | 134 | 0 | 134 |
2016 Febrero | 157 | 0 | 157 |
2016 Enero | 135 | 0 | 135 |
2015 Diciembre | 118 | 0 | 118 |
2015 Noviembre | 131 | 0 | 131 |
2015 Octubre | 145 | 0 | 145 |
2015 Septiembre | 127 | 0 | 127 |
2015 Agosto | 101 | 0 | 101 |
2015 Julio | 141 | 0 | 141 |
2015 Junio | 71 | 0 | 71 |
2015 Mayo | 145 | 0 | 145 |
2015 Abril | 26 | 0 | 26 |
2015 Marzo | 1 | 0 | 1 |